1679955272 NPI number — ALCOHOL AND DRUG ABUSE COUNCIL

Table of content: HYUNG CHAN KIM MD (NPI 1265172209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679955272 NPI number — ALCOHOL AND DRUG ABUSE COUNCIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCOHOL AND DRUG ABUSE COUNCIL
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:
6
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:
1679955272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1053 SCOTTY BEARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75901-3186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-637-9662
Provider Business Mailing Address Fax Number:
936-639-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N RAGUET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUFKIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75904-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-634-5753
Provider Business Practice Location Address Fax Number:
936-639-2638
Provider Enumeration Date:
06/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
FEW
Authorized Official Title or Position:
YOUTH COUNSELOR
Authorized Official Telephone Number:
936-634-5753

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  7946 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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