1700994621 NPI number — CHOON HWA LEE CRNA

Table of content: JOSEPH D HILLMAN CRNA (NPI 1154439065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700994621 NPI number — CHOON HWA LEE CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
CHOON
Provider Middle Name:
HWA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1700994621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8135 SONGBIRD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33496-5133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-414-3245
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 45TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-840-3444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006

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: 367500000X , with the licence number:  033375 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 305503500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G1531 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 033375 . This is a "C.R.N.A.& A.A.N.A." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2559222 . This is a "R.N.LICENCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 021087300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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