1649255159 NPI number — KIM CECILIA LEUNG-STONE M.D.

Table of content: KIM CECILIA LEUNG-STONE M.D. (NPI 1649255159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649255159 NPI number — KIM CECILIA LEUNG-STONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUNG-STONE
Provider First Name:
KIM
Provider Middle Name:
CECILIA
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:
LEUNG-STONE
Provider Other First Name:
KIM
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649255159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2501 COMPASS RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026-8000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-901-5200
Provider Business Mailing Address Fax Number:
847-904-4917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 COMPASS RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-901-5200
Provider Business Practice Location Address Fax Number:
847-904-4917
Provider Enumeration Date:
12/07/2005

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: 207RG0300X , with the licence number:  036070938 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0031601962 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1912186024 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 261093600 . This is a "TAXID/FEIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 216024 . This is a "MEDICARE GROUP PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: K48469 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00465920 . This is a "RAILROAD MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: DG9897 . This is a "RAILROAD MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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