1174990253 NPI number — MRS. KAOCHI DESJHEANNETTE VANG MS OTR

Table of content: MRS. KAOCHI DESJHEANNETTE VANG MS OTR (NPI 1174990253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174990253 NPI number — MRS. KAOCHI DESJHEANNETTE VANG MS OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANG
Provider First Name:
KAOCHI
Provider Middle Name:
DESJHEANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HER
Provider Other First Name:
KAOCHI
Provider Other Middle Name:
DESJHEANNETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174990253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AURORA MEDICAL CENTER OF OSHKOSH - REHAB
Provider Second Line Business Mailing Address:
855 N. WESTHAVEN DRIVE
Provider Business Mailing Address City Name:
OSHKOSH
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-456-7395
Provider Business Mailing Address Fax Number:
920-456-7101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AURORA MEDICAL CENTER OF OSHKOSH - REHAB
Provider Second Line Business Practice Location Address:
855 N. WESTHAVEN DRIVE
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-456-7395
Provider Business Practice Location Address Fax Number:
920-456-7101
Provider Enumeration Date:
08/25/2015

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: 225X00000X , with the licence number:  5701-26 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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