1598773418 NPI number — CLARA M HIGGINS DO PA

Table of content: DR. DAVID CHONG KIM M.D. (NPI 1528202553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598773418 NPI number — CLARA M HIGGINS DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARA M HIGGINS DO PA
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:
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:
1598773418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 ANGLERS ROAD
Provider Second Line Business Mailing Address:
UNIT 104 SAFE HARBOR
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-644-9644
Provider Business Mailing Address Fax Number:
302-644-9646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 ANGLERS ROAD
Provider Second Line Business Practice Location Address:
UNIT 104 SAFE HARBOR
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-9644
Provider Business Practice Location Address Fax Number:
302-644-9646
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HIGGINS
Authorized Official First Name:
CLARA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
GENERAL SURGEON PRESIDENT
Authorized Official Telephone Number:
302-644-9644

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000014382 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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