1053552604 NPI number — DR. DANIEL SOMPOJ TONGBAI M.D.

Table of content: DR. DANIEL SOMPOJ TONGBAI M.D. (NPI 1053552604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053552604 NPI number — DR. DANIEL SOMPOJ TONGBAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONGBAI
Provider First Name:
DANIEL
Provider Middle Name:
SOMPOJ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1053552604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
757 WESTWOOD PLAZA RM 3325
Provider Second Line Business Mailing Address:
RONALD REAGAN UCLA MED CTR
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095-7403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-319-2241
Provider Business Mailing Address Fax Number:
310-319-2263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 16TH ST STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90404-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-319-2241
Provider Business Practice Location Address Fax Number:
310-319-2263
Provider Enumeration Date:
03/11/2009

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: 207L00000X , with the licence number:  A94582 , 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)





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