1598811796 NPI number — BAY AREA SPORTS ORTHOPAEDICS, INC

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 1598811796 NPI number — BAY AREA SPORTS ORTHOPAEDICS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY AREA SPORTS ORTHOPAEDICS, INC
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:
1598811796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1563 SOLANO AVE
Provider Second Line Business Mailing Address:
SUITE 336
Provider Business Mailing Address City Name:
BERKELEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94707-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-834-2276
Provider Business Mailing Address Fax Number:
510-834-2202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 WEBSTER ST
Provider Second Line Business Practice Location Address:
SUITE 907
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-834-2276
Provider Business Practice Location Address Fax Number:
510-834-2202
Provider Enumeration Date:
01/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
510-834-2276

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  A87115 , 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)





Copyright © 2007-2025 www.npivalidator.com