1144360249 NPI number — MISS SUMANA ANUN DDS

Table of content: MISS SUMANA ANUN DDS (NPI 1144360249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144360249 NPI number — MISS SUMANA ANUN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANUN
Provider First Name:
SUMANA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANUNTALABHOCHAI
Provider Other First Name:
SUMANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144360249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3755 N GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAREMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-624-7712
Provider Business Mailing Address Fax Number:
907-624-3755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5467 MORENO ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91763-1682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-946-6771
Provider Business Practice Location Address Fax Number:
909-946-6831
Provider Enumeration Date:
02/07/2007

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: 122300000X , with the licence number:  38641 , 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)

  • Identifier: B3864101 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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