1063664365 NPI number — DR. ELLSWORTH YIN KONG HEW DDS, MS

Table of content: DR. TIFFANY GRAHAM BARBER PHARMD (NPI 1255625539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063664365 NPI number — DR. ELLSWORTH YIN KONG HEW DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEW
Provider First Name:
ELLSWORTH
Provider Middle Name:
YIN KONG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEW
Provider Other First Name:
ELLSWORTH
Provider Other Middle Name:
YIN KONG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ELLSWORTH HEW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063664365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 W COURT ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WOODLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95695-2986
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-661-7799
Provider Business Mailing Address Fax Number:
530-661-7112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 W COURT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WOODLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95695-2986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-661-7799
Provider Business Practice Location Address Fax Number:
530-661-7112
Provider Enumeration Date:
10/17/2008

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: 1223P0300X , with the licence number:  24796 , 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)





Copyright © 2007-2024 www.npivalidator.com