1376827055 NPI number — SOUTH VALLEY DERMATOLOGY AND COSMETIC LASER CENTER INC

Table of content: CHRISTOPHER CHAN DO (NPI 1972998730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376827055 NPI number — SOUTH VALLEY DERMATOLOGY AND COSMETIC LASER CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH VALLEY DERMATOLOGY AND COSMETIC LASER CENTER INC
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:
1376827055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 N IRWIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANFORD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93230-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-582-4510
Provider Business Mailing Address Fax Number:
559-583-6062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 N IRWIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANFORD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93230-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-582-4510
Provider Business Practice Location Address Fax Number:
559-583-6062
Provider Enumeration Date:
09/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-582-4510

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  A80452 , 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)





Copyright © 2007-2025 www.npivalidator.com