1962474460 NPI number — DR. KAREN LIEN M.D.

Table of content: DR. KAREN LIEN M.D. (NPI 1962474460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962474460 NPI number — DR. KAREN LIEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEN
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1962474460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59501-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-262-1302
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVRE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59501-6207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-265-5408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2006

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: 207Q00000X , with the licence number:  8684 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000019121 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 080143918 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1962474460 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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