1164416087 NPI number — TOMIKO GEORGIA STEIN MD, MPH

Table of content: TOMIKO GEORGIA STEIN MD, MPH (NPI 1164416087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164416087 NPI number — TOMIKO GEORGIA STEIN MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
TOMIKO
Provider Middle Name:
GEORGIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1164416087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 N EDGEMONT ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-5209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-783-4798
Provider Business Mailing Address Fax Number:
323-783-4514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 N EDGEMONT ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-5209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-783-4798
Provider Business Practice Location Address Fax Number:
323-783-4514
Provider Enumeration Date:
09/07/2005

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: 207RI0200X , with the licence number:  A54361 , 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: 00A543610 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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