1770674368 NPI number — BRMP PROFESSIONAL MEDICAL CORPORATION

Table of content: DR. BENJAMIN LOUIS KYI DO (NPI 1275094898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770674368 NPI number — BRMP PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRMP PROFESSIONAL MEDICAL CORPORATION
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:
1770674368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92812-7500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-808-9358
Provider Business Mailing Address Fax Number:
714-808-9359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 S EUCLID ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92802-2079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-808-9358
Provider Business Practice Location Address Fax Number:
714-808-9359
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
BAO-THU
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
714-808-9358

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W20498 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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