1588043046 NPI number — DR. KYLE DOUGLAS CHECCHI MD

Table of content: DR. KYLE DOUGLAS CHECCHI MD (NPI 1588043046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588043046 NPI number — DR. KYLE DOUGLAS CHECCHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHECCHI
Provider First Name:
KYLE
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1588043046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3D MEDICAL BATTALION
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMP FOSTER
Provider Business Mailing Address State Name:
OKINAWA
Provider Business Mailing Address Postal Code:
96373
Provider Business Mailing Address Country Code:
JP
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:
NMRTC OKINAWA
Provider Second Line Business Practice Location Address:
DEPARTMENT OF GENERAL SURGERY
Provider Business Practice Location Address City Name:
CAMP FOSTER
Provider Business Practice Location Address State Name:
OKINAWA
Provider Business Practice Location Address Postal Code:
96362
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-646-7148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2015

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: 171000000X , with the licence number:  A143691 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: A143691 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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