1205819828 NPI number — LANKHUE DINH PT

Table of content: LANKHUE DINH PT (NPI 1205819828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205819828 NPI number — LANKHUE DINH PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINH
Provider First Name:
LANKHUE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1205819828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 CLEARFIELD AVE
Provider Second Line Business Mailing Address:
SUITE124
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-1832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-321-3300
Provider Business Mailing Address Fax Number:
757-321-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 GLENN MITCHELL DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-0167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-321-3300
Provider Business Practice Location Address Fax Number:
757-321-3332
Provider Enumeration Date:
11/29/2005

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: 225100000X , with the licence number:  2305202609 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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