1457573529 NPI number — AMERICAN COLLEGE OF TRADITIONAL CHINESE MEDICINE

Table of content: MRS. DEANN MILLER GREEN M.D. (NPI 1982659207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457573529 NPI number — AMERICAN COLLEGE OF TRADITIONAL CHINESE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN COLLEGE OF TRADITIONAL CHINESE MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACTCM
Provider Other Organization Name Type Code:
5
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:
1457573529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 ARKANSAS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-282-9603
Provider Business Mailing Address Fax Number:
415-282-9037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 ARKANSAS STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-282-9603
Provider Business Practice Location Address Fax Number:
415-282-9037
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MLADENOFF
Authorized Official First Name:
PAOLINA
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE BILLING MANAGER
Authorized Official Telephone Number:
415-282-9603

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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