1285931782 NPI number — MR. CHUNG KAY LI P.A.; RPT

Table of content: MR. CHUNG KAY LI P.A.; RPT (NPI 1285931782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285931782 NPI number — MR. CHUNG KAY LI P.A.; RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LI
Provider First Name:
CHUNG
Provider Middle Name:
KAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A.; RPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LI
Provider Other First Name:
WALTER
Provider Other Middle Name:
CHUNG KAY
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA, RPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285931782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93302-1484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-368-8308
Provider Business Mailing Address Fax Number:
661-792-3095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93215-2246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-474-2600
Provider Business Practice Location Address Fax Number:
661-474-2600
Provider Enumeration Date:
02/17/2011

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: 363AM0700X , with the licence number:  PA15269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT8718 , 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)





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