1346240462 NPI number — LAYKOON TAN HUANG MD MPH

Table of content: CHARLES ELLIS (NPI 1255109765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346240462 NPI number — LAYKOON TAN HUANG MD MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUANG
Provider First Name:
LAYKOON
Provider Middle Name:
TAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD MPH
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:
1346240462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 W INSKIP DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37912-4058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-687-2277
Provider Business Mailing Address Fax Number:
865-689-5336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 W INSKIP DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-687-2277
Provider Business Practice Location Address Fax Number:
865-689-5336
Provider Enumeration Date:
07/29/2005

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: 2083X0100X , with the licence number:  24365 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 9319 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3181944 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 602003574 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 182662 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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