1881920247 NPI number — ANITA KUNDI D.O I.N.C

Table of content: (NPI 1881920247)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881920247 NPI number — ANITA KUNDI D.O I.N.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANITA KUNDI D.O I.N.C
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:
1881920247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12598 #219 CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CHINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-591-1444
Provider Business Mailing Address Fax Number:
909-591-7785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12598 #219 CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CHINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91710-3573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-591-1444
Provider Business Practice Location Address Fax Number:
909-591-7785
Provider Enumeration Date:
10/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KUNDI
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-591-1444

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  20A67250 , 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: 020A67250 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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