1487739322 NPI number — HUNTINGTON RADIATION ONCOLOGY MEDICAL GROUP

Table of content: (NPI 1487739322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487739322 NPI number — HUNTINGTON RADIATION ONCOLOGY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON RADIATION ONCOLOGY MEDICAL GROUP
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:
1487739322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 67808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-7365
Provider Business Mailing Address Fax Number:
310-273-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 S. FAIROAKS AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-397-5149
Provider Business Practice Location Address Fax Number:
626-397-2147
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAM
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-397-5149

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A42358 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0001X , with the licence number: A42358 , 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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