1750453577 NPI number — DR. JOANNA M. OSUGA MD

Table of content: MOHINDER CHADHA M.D. (NPI 1457394843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750453577 NPI number — DR. JOANNA M. OSUGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSUGA
Provider First Name:
JOANNA
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IKEDA
Provider Other First Name:
JOANNA
Provider Other Middle Name:
MIROKU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750453577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2025 MORSE AVE
Provider Second Line Business Mailing Address:
KAISER FOUNDATION HOSPITAL, EMERGENCY DEPARTMENT
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95825-2115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-973-1655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2025 MORSE AVE
Provider Second Line Business Practice Location Address:
KAISER FOUNDATION HOSPITAL, EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95825-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-973-1655
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2006

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: 207P00000X , with the licence number:  G69768 , 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: 00G697680 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".