1306832498 NPI number — DR. KYUNG K INCORVATI M.D.

Table of content: DR. KYUNG K INCORVATI M.D. (NPI 1306832498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306832498 NPI number — DR. KYUNG K INCORVATI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INCORVATI
Provider First Name:
KYUNG
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1306832498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1520 3RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15066-2204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-843-3800
Provider Business Mailing Address Fax Number:
724-843-4799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 BOUNDRY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-843-3800
Provider Business Practice Location Address Fax Number:
724-843-4799
Provider Enumeration Date:
09/23/2005

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: 208600000X , with the licence number:  MD067851L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017780330006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com