1417154113 NPI number — DR. TAAS NAKA WORLEY KING D.O

Table of content: MICAH KNIGHT OT-A (NPI 1295190668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417154113 NPI number — DR. TAAS NAKA WORLEY KING D.O

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
TAAS
Provider Middle Name:
NAKA WORLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WORLEY
Provider Other First Name:
TAAS
Provider Other Middle Name:
NAKA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417154113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 SE 164TH AVE
Provider Second Line Business Mailing Address:
DEPT 358
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-9324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-788-6870
Provider Business Mailing Address Fax Number:
360-788-6872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 BIRCHWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-788-6870
Provider Business Practice Location Address Fax Number:
360-788-6872
Provider Enumeration Date:
06/27/2007

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: 2084N0400X , with the licence number:  5101017375 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: OP60463152 , 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)

  • Identifier: 1417154113 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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