1801169222 NPI number — DR. DENISE W KWAN BROWN O.T.D.

Table of content: DR. DENISE W KWAN BROWN O.T.D. (NPI 1801169222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801169222 NPI number — DR. DENISE W KWAN BROWN O.T.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
DENISE
Provider Middle Name:
W KWAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.T.D.
Provider Gender Code:
F

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:
1801169222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 93092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CITY OF INDUSTRY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91715-3092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15454 GALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-801-6660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2012

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: 174400000X , with the licence number:  7208 , 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: 032512070629 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120703250629 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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