1427806272 NPI number — WYNN MEDICAL CENTER RHEUMATOLOGY-DERMATOLOGY

Table of content: (NPI 1427806272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427806272 NPI number — WYNN MEDICAL CENTER RHEUMATOLOGY-DERMATOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYNN MEDICAL CENTER RHEUMATOLOGY-DERMATOLOGY
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:
1427806272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9126 VALLEY BLVD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEMEAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91770-1987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-573-9003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11420 RAMONA BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-2743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-573-9003
Provider Business Practice Location Address Fax Number:
626-573-0641
Provider Enumeration Date:
05/07/2024

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
HUYNH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
616-990-0782

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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