1114131018 NPI number — PROF. ANNE YOUNGRAN MAEDO D.C.

Table of content: PROF. ANNE YOUNGRAN MAEDO D.C. (NPI 1114131018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114131018 NPI number — PROF. ANNE YOUNGRAN MAEDO D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAEDO
Provider First Name:
ANNE
Provider Middle Name:
YOUNGRAN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOO
Provider Other First Name:
YOUNG
Provider Other Middle Name:
RAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114131018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7212 ORANGETHORPE AVE STE 3B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUENA PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90621-4660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-539-3793
Provider Business Mailing Address Fax Number:
714-539-3952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7212 ORANGETHORPE AVE STE 3B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUENA PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90621-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-539-3793
Provider Business Practice Location Address Fax Number:
714-539-3952
Provider Enumeration Date:
05/09/2007

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: 111N00000X , with the licence number:  21177 , 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)