1225226228 NPI number — CHRISTOPHER J KRPAN DO PSC

Table of content: (NPI 1225226228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225226228 NPI number — CHRISTOPHER J KRPAN DO PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTOPHER J KRPAN DO PSC
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:
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:
1225226228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7096
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95267-0096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-956-7725
Provider Business Mailing Address Fax Number:
209-956-7733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 KURT DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ANGELS CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95222-9324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-736-1147
Provider Business Practice Location Address Fax Number:
209-736-8094
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRPAN
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
209-736-1147

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  20A7650 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 5209930001 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00AX76500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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