1053511873 NPI number — TAPAN ROY MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053511873 NPI number — TAPAN ROY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAPAN ROY MD PC
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:
1053511873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7330 HICKORYWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94566-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-504-2009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14662 NEWPORT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-573-9500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROY
Authorized Official First Name:
TAPAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
314-504-2009

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  R4B37 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R4B37 . This is a "MISSOURI PROFESSIONAL LIC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 201528106 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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