1104970490 NPI number — JAMES W JELINEK DDS & SUSAN A YUNG DDS P C

Table of content: (NPI 1104970490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104970490 NPI number — JAMES W JELINEK DDS & SUSAN A YUNG DDS P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES W JELINEK DDS & SUSAN A YUNG DDS P C
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:
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:
1104970490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 ROCK POINTE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20186-2630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-349-0033
Provider Business Mailing Address Fax Number:
540-347-5872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 ROCK POINTE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-349-0033
Provider Business Practice Location Address Fax Number:
540-347-5872
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JELINEK
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
540-349-0033

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6730 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 6688 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 234018 . This is a "ANTHEM PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 234019 . This is a "ANTHEM PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 817559 . This is a "UCCI PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 00606001 . This is a "DELTA DENTAL PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com