1942200746 NPI number — STANLEY Y. LOUIE DO, INC

Table of content: SYED ASHAD ABID MD (NPI 1578948261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942200746 NPI number — STANLEY Y. LOUIE DO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANLEY Y. LOUIE DO, INC
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:
LOGAN STREET MEDICAL GROUP
Provider Other Organization Name Type Code:
3
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:
1942200746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2511 LOGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93662-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-896-2624
Provider Business Mailing Address Fax Number:
559-896-3235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2511 LOGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93662-3012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-896-2624
Provider Business Practice Location Address Fax Number:
559-896-3235
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LOUIE
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
YOUNG
Authorized Official Title or Position:
PRESIDEN/MEDICAL DIRECTOR
Authorized Official Telephone Number:
559-896-2624

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A65700 , 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: GR0081530 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ53815Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020A65700 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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