1508856212 NPI number — DCSFHP, OHS, 18TH MEDCOM

Table of content: (NPI 1508856212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508856212 NPI number — DCSFHP, OHS, 18TH MEDCOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DCSFHP, OHS, 18TH MEDCOM
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:
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:
1508856212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HSC 168TH MED BN, UNIT 15021, BOX 10-B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96218
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
53-470-5567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
168TH MED BN UNIT 15021, BOX 10-B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
01182537645567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHO
Authorized Official First Name:
KUN AI
Authorized Official Middle Name:
Authorized Official Title or Position:
OCCUPATIONAL HEALTH NURSE
Authorized Official Telephone Number:
53-470-5567

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X , with the licence number:  0001131457 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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