1508611823 NPI number — TERENCE YIMNAI TENDZONG III NURSE

Table of content: TERENCE YIMNAI TENDZONG III NURSE (NPI 1508611823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508611823 NPI number — TERENCE YIMNAI TENDZONG III NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TENDZONG
Provider First Name:
TERENCE
Provider Middle Name:
YIMNAI
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
NURSE
Provider Gender Code:
M

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:
1508611823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 E DUBLIN GRANVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43085-3192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-844-3800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5867 FOREST HILLS BOULIVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-207-8877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2024

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com