1508426420 NPI number — KUONG NGANN DO CORP

Table of content: (NPI 1508426420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508426420 NPI number — KUONG NGANN DO CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KUONG NGANN DO 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:
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:
1508426420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 E GLENARM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-3418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-768-4415
Provider Business Mailing Address Fax Number:
626-403-0321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 CONSTITUTION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93906-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-755-4111
Provider Business Practice Location Address Fax Number:
626-403-0321
Provider Enumeration Date:
06/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NGANN
Authorized Official First Name:
KUONG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-755-4196

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20A12099 . This is a "CA LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com