1598701062 NPI number — VALLEY INTEGRATED HEALTH CARE SERVICE

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 1598701062 NPI number — VALLEY INTEGRATED HEALTH CARE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY INTEGRATED HEALTH CARE SERVICE
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:
6
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:
1598701062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 BALBOA BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91325-5403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-701-8771
Provider Business Mailing Address Fax Number:
818-701-0073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 BALBOA BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-5403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-701-8771
Provider Business Practice Location Address Fax Number:
818-701-0073
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOI
Authorized Official First Name:
SANG
Authorized Official Middle Name:
HEE
Authorized Official Title or Position:
SACRETARY
Authorized Official Telephone Number:
818-701-8771

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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