1730323866 NPI number — MS. CHINA KEYONNIE GASSOWAY STEVENSON

Table of content: MS. CHINA KEYONNIE GASSOWAY STEVENSON (NPI 1730323866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730323866 NPI number — MS. CHINA KEYONNIE GASSOWAY STEVENSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GASSOWAY STEVENSON
Provider First Name:
CHINA
Provider Middle Name:
KEYONNIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1730323866
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3605 LONG BEACH BLVD
Provider Second Line Business Mailing Address:
SUITE 331
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90807-4013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-989-0515
Provider Business Mailing Address Fax Number:
562-421-7221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 WATSON PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-421-7225
Provider Business Practice Location Address Fax Number:
562-421-7221
Provider Enumeration Date:
04/20/2009

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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