1679936777 NPI number — NEX'S TRADITIONAL CHINESE MEDICINE

Table of content: (NPI 1679936777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679936777 NPI number — NEX'S TRADITIONAL CHINESE MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEX'S TRADITIONAL CHINESE MEDICINE
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:
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:
1679936777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 N GAREY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91767-3804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 N GAREY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-629-8787
Provider Business Practice Location Address Fax Number:
909-629-8787
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ZHU
Authorized Official First Name:
XIAONING
Authorized Official Middle Name:
Authorized Official Title or Position:
ACUPUNCTURE
Authorized Official Telephone Number:
909-629-8787

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC14956 , 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)

  • Identifier: AC14956 . This is a "BLUE CROSS PPO, BULE SHIELD PPO, AETNA PPO, KAISER-PERMANENTE, ECT." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AC14956 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AC14956 . This is a "UNIFED HEALTH CARE, HEALTH NET, CIGNA, NET WORK, MEDICARE." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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