1609081587 NPI number — MS. HAIYAN SHI HAWKES LAC,, C.M.D.

Table of content: MS. HAIYAN SHI HAWKES LAC,, C.M.D. (NPI 1609081587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609081587 NPI number — MS. HAIYAN SHI HAWKES LAC,, C.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKES
Provider First Name:
HAIYAN
Provider Middle Name:
SHI
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC,, C.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LI
Provider Other First Name:
HAIYAN
Provider Other Middle Name:
SHI
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC., C.M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609081587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16220 FREDERICK RD
Provider Second Line Business Mailing Address:
SUITE 404
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20877-4039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-654-1240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16220 FREDERICK RD
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-4039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-654-1240
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2007

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: 171100000X , with the licence number:  U01258 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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