1235307109 NPI number — MRS. JOANNE TU-OZO VAN KIRK AA

Table of content: MRS. JOANNE TU-OZO VAN KIRK AA (NPI 1235307109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235307109 NPI number — MRS. JOANNE TU-OZO VAN KIRK AA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN KIRK
Provider First Name:
JOANNE
Provider Middle Name:
TU-OZO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TU-OZO
Provider Other First Name:
JOANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
AA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235307109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9330 59TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-2858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-581-7020
Provider Business Mailing Address Fax Number:
253-620-5831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 59TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-2858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-581-7020
Provider Business Practice Location Address Fax Number:
253-620-5831
Provider Enumeration Date:
02/13/2008

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: 101YM0800X , with the licence number:  RC00060199 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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