1588039309 NPI number — JUNGHWA LEE PERKINS RN

Table of content: JUNGHWA LEE PERKINS RN (NPI 1588039309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588039309 NPI number — JUNGHWA LEE PERKINS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERKINS
Provider First Name:
JUNGHWA
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
JUNGHWA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588039309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9040 REID STREET, ATTN: MCHJ-CLQ-C
Provider Second Line Business Mailing Address:
MADIGAN ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-1110
Provider Business Mailing Address Fax Number:
253-968-2149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9040 REID STREET, ATTN: MCHJ-CLQ-C
Provider Second Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CENTER
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-1110
Provider Business Practice Location Address Fax Number:
253-968-2149
Provider Enumeration Date:
12/04/2015

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: 163W00000X , with the licence number:  60565817 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 592759 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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