1659586634 NPI number — KARLEEN KEHAU HARMONY JAKOWSKI

Table of content: KARLEEN KEHAU HARMONY JAKOWSKI (NPI 1659586634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659586634 NPI number — KARLEEN KEHAU HARMONY JAKOWSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAKOWSKI
Provider First Name:
KARLEEN
Provider Middle Name:
KEHAU HARMONY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WATSON
Provider Other First Name:
KARLEEN
Provider Other Middle Name:
KEHAU HARMONY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659586634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/23/2023
NPI Reactivation Date:
03/01/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1965 LIVE OAK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YUBA CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95991-8850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-822-7478
Provider Business Mailing Address Fax Number:
530-822-7484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1965 LIVE OAK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUBA CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95991-8850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-822-7478
Provider Business Practice Location Address Fax Number:
530-822-7484
Provider Enumeration Date:
05/11/2007

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: 101YM0800X , with the licence number:  0125871 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: IMF-58871 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFC 53472 , 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)