1588693261 NPI number — KAE T AUNG 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 1588693261 NPI number — KAE T AUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUNG
Provider First Name:
KAE
Provider Middle Name:
T
Provider Name Prefix Text:
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:
1588693261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7373 WEST LN
Provider Second Line Business Mailing Address:
STE 165
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95210-3377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-876-7820
Provider Business Mailing Address Fax Number:
530-876-7805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6470 PENTZ RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PARADISE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95969-3674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-876-7820
Provider Business Practice Location Address Fax Number:
530-876-7805
Provider Enumeration Date:
07/03/2006

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: 207R00000X , with the licence number:  D0051738 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07391 . This is a "PREFERRED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1010184 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13070003 . This is a "CAREFIRST OF DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 52029-01 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: A73806 . This is a "PROFESSIONAL LICENSURE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BM797 . This is a "MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P13195 . This is a "CAREFIRST BCBS POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4421680 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5293630 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1220043 . This is a "FIRST HEALTH/CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54733401 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8964863002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134250900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2429707 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 855698 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG3783 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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