1588635825 NPI number — DR. JEFFREY LEE HAIUM DMD, ABGD

Table of content: DR. JEFFREY LEE HAIUM DMD, ABGD (NPI 1588635825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588635825 NPI number — DR. JEFFREY LEE HAIUM DMD, ABGD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAIUM
Provider First Name:
JEFFREY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, ABGD
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:
1588635825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG 9900, 2ND FLOOR
Provider Second Line Business Mailing Address:
U.S. ARMY DENTAL ACTIVITY - FT LEWIS
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-4039
Provider Business Mailing Address Fax Number:
253-968-5919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 422
Provider Second Line Business Practice Location Address:
U.S. ARMY DENTAL CLINIC COMMAND - POM
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93944-5810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-242-5612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2006

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: 1223G0001X , with the licence number:  28566 , 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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