1598771370 NPI number — DR. CHUN KYU LOWE M.D., PH.D.

Table of content: DR. CHUN KYU LOWE M.D., PH.D. (NPI 1598771370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598771370 NPI number — DR. CHUN KYU LOWE M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOWE
Provider First Name:
CHUN
Provider Middle Name:
KYU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOH
Provider Other First Name:
CHUN
Provider Other Middle Name:
KYU
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D., PH.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598771370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GRAND AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631
Provider Business Mailing Address Country Code:
US
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:
200 GRAND AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-4371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-568-8411
Provider Business Practice Location Address Fax Number:
201-568-5367
Provider Enumeration Date:
07/31/2006

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: 208G00000X , with the licence number:  MA36027 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3846008 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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