1952476855 NPI number — SERGEY V LOZAN DDS

Table of content: SERGEY V LOZAN DDS (NPI 1952476855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952476855 NPI number — SERGEY V LOZAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOZAN
Provider First Name:
SERGEY
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1952476855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
875 140 AVE NE
Provider Second Line Business Mailing Address:
#102
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-747-4445
Provider Business Mailing Address Fax Number:
425-747-1874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
875 140 AVE NE
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-747-4445
Provider Business Practice Location Address Fax Number:
425-747-1874
Provider Enumeration Date:
11/24/2006

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: 1223G0001X , with the licence number:  DE00007563 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3287LO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5023684 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57563 . This is a "WA DENTAL SERVICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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