1124440060 NPI number — MS. SUSANA GYEK GOY D.C. DOCTOR OF CHIRO

Table of content: MS. SUSANA GYEK GOY D.C. DOCTOR OF CHIRO (NPI 1124440060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124440060 NPI number — MS. SUSANA GYEK GOY D.C. DOCTOR OF CHIRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOY
Provider First Name:
SUSANA
Provider Middle Name:
GYEK
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.C. DOCTOR OF CHIRO
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:
1124440060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11123 LONG BEACH BLVD. SUITE 5
Provider Second Line Business Mailing Address:
LYNWOOD HEALTH CENTER
Provider Business Mailing Address City Name:
LYNWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-604-6940
Provider Business Mailing Address Fax Number:
310-604-6996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11123 LONG BEACH BLVD. SUITE 5
Provider Second Line Business Practice Location Address:
LYNWOOD HEALTH CENTER
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-604-6940
Provider Business Practice Location Address Fax Number:
310-604-6996
Provider Enumeration Date:
01/13/2014

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:  DC28668 , 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)





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