1467972471 NPI number — DR. KATHERINE ELISE MCDANIEL MD

Table of content: DR. LINDSAY MARIE FOREMAN DMD (NPI 1215442017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467972471 NPI number — DR. KATHERINE ELISE MCDANIEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL
Provider First Name:
KATHERINE
Provider Middle Name:
ELISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1467972471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 N. STATE STREET, IPT C3F107
Provider Second Line Business Mailing Address:
LAC USC MEDICAL CENTER
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90033-1029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-409-8848
Provider Business Mailing Address Fax Number:
323-441-7219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N. STATE STREET
Provider Second Line Business Practice Location Address:
IPT C3F107
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-8848
Provider Business Practice Location Address Fax Number:
323-441-7219
Provider Enumeration Date:
06/21/2017

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: 207VE0102X , with the licence number:  A158309 , 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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