1215932512 NPI number — DR. CHAU N KOVACH MD

Table of content: DR. CHAU N KOVACH MD (NPI 1215932512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215932512 NPI number — DR. CHAU N KOVACH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVACH
Provider First Name:
CHAU
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN-DANG
Provider Other First Name:
CHAU-THUONG
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215932512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 W CENTRAL AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67212-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-722-6260
Provider Business Mailing Address Fax Number:
316-721-8307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
929 N SAINT FRANCIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-268-5000
Provider Business Practice Location Address Fax Number:
316-291-4396
Provider Enumeration Date:
06/15/2005

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: 207R00000X , with the licence number:  0429856 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100450290D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".