1659550226 NPI number — SUSAN S HONG CRANDALL NP

Table of content: SUSAN S HONG CRANDALL NP (NPI 1659550226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659550226 NPI number — SUSAN S HONG CRANDALL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONG CRANDALL
Provider First Name:
SUSAN
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HONG-CRANDALL; HONG
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659550226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4151 MIDDLEFIELD RD
Provider Second Line Business Mailing Address:
SUITE111
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94303-4753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-327-8888
Provider Business Mailing Address Fax Number:
650-269-8624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4151 MIDDLEFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94303-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-327-8888
Provider Business Practice Location Address Fax Number:
650-269-8624
Provider Enumeration Date:
10/30/2007

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: 363LA2100X , with the licence number:  RN468870 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: NPF 17502 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: NPF 17502 . This is a "CA BRN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: NP17502 . This is a "CA BRN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".