1982975660 NPI number — DR. KAMARR AVIDON WILMINGTON RICHEE M.C.

Table of content: DR. KAMARR AVIDON WILMINGTON RICHEE M.C. (NPI 1982975660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982975660 NPI number — DR. KAMARR AVIDON WILMINGTON RICHEE M.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILMINGTON RICHEE
Provider First Name:
KAMARR
Provider Middle Name:
AVIDON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHEE
Provider Other First Name:
KAMARR
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982975660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11551 FAYE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92840-1948
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:
2101 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-542-3581
Provider Business Practice Location Address Fax Number:
714-542-2246
Provider Enumeration Date:
01/26/2012

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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