1467576017 NPI number — ABC DENTAL GROUP,DR'S FAY,MYINT,AUNG A PROF.DENTAL CORP.

Table of content: (NPI 1467576017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467576017 NPI number — ABC DENTAL GROUP,DR'S FAY,MYINT,AUNG A PROF.DENTAL CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABC DENTAL GROUP,DR'S FAY,MYINT,AUNG A PROF.DENTAL CORP.
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:
6
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:
1467576017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2544 S MOONEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93277-6237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-733-9797
Provider Business Mailing Address Fax Number:
559-739-0786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2544 S MOONEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93277-6237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-733-9797
Provider Business Practice Location Address Fax Number:
559-739-0786
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FAY
Authorized Official First Name:
MEHRDAD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
559-733-9797

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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)

  • Identifier: 185601 . This is a "DELTA CARE USA-HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 159654 . This is a "CIGNA HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1626 . This is a "CALIFORNIADENTAL NETWORK" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 13674 . This is a "PACIFIC UNION DENTAL HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 761 . This is a "DENTAL NET HMO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B40815-01 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 349835 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B40815-01 . This is a "HEALTHY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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