1598296766 NPI number — JENNY JIHAE HE PA-C

Table of content: JENNY JIHAE HE PA-C (NPI 1598296766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598296766 NPI number — JENNY JIHAE HE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HE
Provider First Name:
JENNY
Provider Middle Name:
JIHAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
JENNY
Provider Other Middle Name:
JIHAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598296766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 SETON PKWY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78665-8002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-687-2300
Provider Business Practice Location Address Fax Number:
512-687-2350
Provider Enumeration Date:
03/21/2017

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 369809401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 369809402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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