1770510638 NPI number — KHUONG TUAN DINH

Table of content: KHUONG TUAN DINH (NPI 1770510638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770510638 NPI number — KHUONG TUAN DINH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINH
Provider First Name:
KHUONG
Provider Middle Name:
TUAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1770510638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4117 S STAPLES ST
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78411-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-993-6117
Provider Business Mailing Address Fax Number:
361-992-1375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4117 S STAPLES ST
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78411-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-993-6117
Provider Business Practice Location Address Fax Number:
361-992-1375
Provider Enumeration Date:
06/27/2006

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: 152W00000X , with the licence number:  6068TG , 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)

  • Identifier: 16193 . This is a "SPECTERA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 412069309 . This is a "CHIP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 451932 . This is a "NVA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153761501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 38695 . This is a "AVESIS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 57092 . This is a "SAFEGUARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9917 . This is a "DAVIS VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 412069309 . This is a "SUPERIOR VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 919125 . This is a "BLOCK VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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