1699291476 NPI number — VONNE HONG PERRY-BURKHARDT LMFT

Table of content: VONNE HONG PERRY-BURKHARDT LMFT (NPI 1699291476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699291476 NPI number — VONNE HONG PERRY-BURKHARDT LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY-BURKHARDT
Provider First Name:
VONNE
Provider Middle Name:
HONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
U

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699291476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/10/2023
NPI Reactivation Date:
02/13/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 N EUCALYPTUS AVE APT 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90302-3631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-741-1561
Provider Business Mailing Address Fax Number:
323-948-0443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 N EUCALYPTUS AVE APT 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90302-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-741-1561
Provider Business Practice Location Address Fax Number:
323-948-0443
Provider Enumeration Date:
08/14/2017

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: 106H00000X , with the licence number:  LMFT119458 , 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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