1669873782 NPI number — JBJC INC.

Table of content: (NPI 1669873782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669873782 NPI number — JBJC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JBJC INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1669873782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
534 E PINE ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95204-5536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-463-5800
Provider Business Mailing Address Fax Number:
209-463-5900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 S FAIRMONT AVE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-339-1690
Provider Business Practice Location Address Fax Number:
209-339-1693
Provider Enumeration Date:
09/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BOB
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DPT / OWNER / PRESIDENT
Authorized Official Telephone Number:
209-451-3920

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZ23015Z . This is a "PROVIDER (PTAN)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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