1205060720 NPI number — VALLEY ORAL AND MAXILLOFACIAL SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205060720 NPI number — VALLEY ORAL AND MAXILLOFACIAL SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY ORAL AND MAXILLOFACIAL SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205060720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3604 FAIR OAKS BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95864-7253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3604 FAIR OAKS BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95864-7253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-217-1591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CHIANG
Authorized Official First Name:
NANLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ORAL SURGEON
Authorized Official Telephone Number:
916-217-1591

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  54820 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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