1346445764 NPI number — DR. KAKIN ROBERT IONG M.D.

Table of content: DR. KAKIN ROBERT IONG M.D. (NPI 1346445764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346445764 NPI number — DR. KAKIN ROBERT IONG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IONG
Provider First Name:
KAKIN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IONG
Provider Other First Name:
ROBERT
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1346445764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
474 48TH AVE APT 8G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG ISLAND CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11109-5610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-453-3799
Provider Business Mailing Address Fax Number:
702-453-5741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRITT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50423-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-453-3799
Provider Business Practice Location Address Fax Number:
702-453-5741
Provider Enumeration Date:
06/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A112656 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 258334 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 58590 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD-42546 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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