1699841148 NPI number — KAZUKO K PRICE MD LTD

Table of content: (NPI 1699841148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699841148 NPI number — KAZUKO K PRICE MD LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAZUKO K PRICE MD LTD
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:
1699841148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 KENMORE AVENUE
Provider Second Line Business Mailing Address:
SUITE 118
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22304-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-751-3344
Provider Business Mailing Address Fax Number:
703-751-3345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 KENMORE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-751-3344
Provider Business Practice Location Address Fax Number:
703-751-3345
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
KAZUKO
Authorized Official Middle Name:
KUKITA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-751-3344

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  0101015073 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2908 . This is a "CARE FIRST DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 043401 . This is a "ANTHEM INC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com