1154452142 NPI number — HOMER KAM YUN LEW D.O.

Table of content: HOMER KAM YUN LEW D.O. (NPI 1154452142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154452142 NPI number — HOMER KAM YUN LEW D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEW
Provider First Name:
HOMER
Provider Middle Name:
KAM YUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1154452142
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23521 PASEO DE VALENCIA
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-588-7262
Provider Business Mailing Address Fax Number:
949-588-7260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23521 PASEO DE VALENCIA
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-588-7262
Provider Business Practice Location Address Fax Number:
949-588-7260
Provider Enumeration Date:
03/08/2007

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: 207R00000X , with the licence number:  20A7156 , 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: 20A7156 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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