1639377450 NPI number — RITA B. CHUANG, MD LLC

Table of content: (NPI 1639377450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639377450 NPI number — RITA B. CHUANG, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RITA B. CHUANG, MD LLC
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:
RITA B. CHUANG, MD LLC
Provider Other Organization Name Type Code:
4
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:
1639377450
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:
2629 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
140
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-2897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-818-3207
Provider Business Mailing Address Fax Number:
702-818-4759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2629 W HORIZON RIDGE PKWY
Provider Second Line Business Practice Location Address:
140
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-818-3207
Provider Business Practice Location Address Fax Number:
702-818-4759
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHUANG
Authorized Official First Name:
RITA
Authorized Official Middle Name:
BELLA
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
702-818-3207

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9659 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 8906 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2018639 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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