1003000761 NPI number — MS. PATRICIA LEON GUERRERO TAIMANGLO PHD

Table of content: DR. SAE HWAN CHUNG DDS (NPI 1972759983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003000761 NPI number — MS. PATRICIA LEON GUERRERO TAIMANGLO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAIMANGLO
Provider First Name:
PATRICIA
Provider Middle Name:
LEON GUERRERO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIER
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
TAIMANGLO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003000761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 S MARINE CORPS DRIVE
Provider Second Line Business Mailing Address:
SUITE 219 GITC BLDG
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-649-2080
Provider Business Mailing Address Fax Number:
671-649-2082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 S MARINE CORPS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 219 GITC BLDG
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-649-2080
Provider Business Practice Location Address Fax Number:
671-649-2083
Provider Enumeration Date:
09/05/2007

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: 103TC0700X , with the licence number:  CP000022 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY705 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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