1487091708 NPI number — DR. NIKKIE RANDHAWA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487091708 NPI number — DR. NIKKIE RANDHAWA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RANDHAWA
Provider First Name:
NIKKIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487091708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/27/2014
NPI Reactivation Date:
08/21/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 MCCALLUM ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBOTSFORD
Provider Business Mailing Address State Name:
BRITISH COLUMBIA
Provider Business Mailing Address Postal Code:
V2S8A1
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204-145 13TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH VANCOUVER
Provider Business Practice Location Address State Name:
BC
Provider Business Practice Location Address Postal Code:
V7L2L4
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
604-924-4009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2013

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: 2084N0600X , with the licence number:  LP03907 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29016 . This is a "COLLEGE OF PHYSICIANS & SURGEONS OF BC" identifier . This identifiers is of the category "OTHER".