1629465323 NPI number — MICHELLE TAEHEE-EVANS NG 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 1629465323 NPI number — MICHELLE TAEHEE-EVANS NG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NG
Provider First Name:
MICHELLE
Provider Middle Name:
TAEHEE-EVANS
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:
EVANS
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
TAEHEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629465323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11234 ANDERSON ST
Provider Second Line Business Mailing Address:
GME OFFICE WESTERLY SUITE C
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92354-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-558-6131
Provider Business Mailing Address Fax Number:
909-558-0430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11234 ANDERSON ST
Provider Second Line Business Practice Location Address:
LOMA LINDA UNIVERSITY HEALTH - PHYSICAL MEDICINE/REHAB
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-558-6202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2015

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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