1154554673 NPI number — ACME CONSULTATIVE EVALUATION MEDICAL CENTER

Table of content: MR. TIMOTHY VIET THAI RPH (NPI 1659959435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154554673 NPI number — ACME CONSULTATIVE EVALUATION MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACME CONSULTATIVE EVALUATION MEDICAL CENTER
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:
1154554673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14482 BEACH BLVD
Provider Second Line Business Mailing Address:
# R
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92683-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-889-7255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14482 BEACH BLVD
Provider Second Line Business Practice Location Address:
# R
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92683-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-889-7255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LAI
Authorized Official First Name:
HOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
714-889-7255

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X , with the licence number:  G58330 , 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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