1851840201 NPI number — NATHAN HUNT LLC

Table of content: DR. KAYWAN DINYAR GAMADIA D.O (NPI 1063699833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851840201 NPI number — NATHAN HUNT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATHAN HUNT LLC
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:
6
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:
1851840201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19341 BEAR VALLEY RD
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92308-5151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-998-9503
Provider Business Mailing Address Fax Number:
760-998-2662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15055 VISTA RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
HELENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92342-7717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-983-2599
Provider Business Practice Location Address Fax Number:
760-983-2662
Provider Enumeration Date:
09/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BUDGE
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
HUNT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-983-2599

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , 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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