1679666333 NPI number — EDDIE P LO DPM AND NATALIE T CHU DPM PLLC

Table of content: (NPI 1679666333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679666333 NPI number — EDDIE P LO DPM AND NATALIE T CHU DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDDIE P LO DPM AND NATALIE T CHU DPM PLLC
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:
1679666333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2302 S UNION AVE STE B18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-572-4848
Provider Business Mailing Address Fax Number:
253-572-1803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2302 S UNION AVE STE B18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-572-4848
Provider Business Practice Location Address Fax Number:
253-572-1803
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LO
Authorized Official First Name:
EDDIE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
253-572-4848

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO00000633 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 480026920 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 215605 . This is a "LABOR AND INDUSTIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7136294 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF9966 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5197ED . This is a "REGENCE GROUP RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1106012 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1106822 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480028963 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5207100001 . This is a "DMEPOS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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