1144363995 NPI number — SINGH A. BOUN, MD & NICK LEE, MD, A PROFESSIONAL CORPORATION

Table of content: (NPI 1144363995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144363995 NPI number — SINGH A. BOUN, MD & NICK LEE, MD, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SINGH A. BOUN, MD & NICK LEE, MD, A PROFESSIONAL CORPORATION
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:
6
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:
1144363995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 N GARFIELD AVE
Provider Second Line Business Mailing Address:
SUITE #201
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91754-1746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-280-5000
Provider Business Mailing Address Fax Number:
626-280-5100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N GARFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-280-5000
Provider Business Practice Location Address Fax Number:
626-280-5100
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOUN
Authorized Official First Name:
SINGH
Authorized Official Middle Name:
AHN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-280-5000

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A79658 , 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: 00A796581 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A796580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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