1609007939 NPI number — MS. SHERI CHONG OTR/L, IMC, SIPT CER

Table of content: MS. SHERI CHONG OTR/L, IMC, SIPT CER (NPI 1609007939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609007939 NPI number — MS. SHERI CHONG OTR/L, IMC, SIPT CER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHONG
Provider First Name:
SHERI
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, IMC, SIPT CER
Provider Gender Code:
F

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:
1609007939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3205 HURLEY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95864-3853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-485-6711
Provider Business Mailing Address Fax Number:
916-485-2653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6960 DESTINY DR, STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95677-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-947-1812
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2009

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: 225XP0200X , with the licence number:  3752 , 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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