1376636092 NPI number — DR. KAREN PATRICIA VAN DYKE DDS

Table of content: DR. KAREN PATRICIA VAN DYKE DDS (NPI 1376636092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376636092 NPI number — DR. KAREN PATRICIA VAN DYKE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN DYKE
Provider First Name:
KAREN
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DYKE
Provider Other First Name:
K. TRISH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376636092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20615 COMMERCE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-335-3521
Provider Business Mailing Address Fax Number:
530-335-5558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20615 COMMERCE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-335-3521
Provider Business Practice Location Address Fax Number:
530-335-5558
Provider Enumeration Date:
10/02/2006

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: 1223G0001X , with the licence number:  37301 , 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)

  • Identifier: B37301-02 . This is a "HEALTY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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