1962893040 NPI number — MRS. LILY NGUYEN KIRKLAND M.A.

Table of content: MRS. LILY NGUYEN KIRKLAND M.A. (NPI 1962893040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962893040 NPI number — MRS. LILY NGUYEN KIRKLAND M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRKLAND
Provider First Name:
LILY
Provider Middle Name:
NGUYEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1962893040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 CITY BLVD WEST
Provider Second Line Business Mailing Address:
APT. 214
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-943-4385
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 CITY BLVD W
Provider Second Line Business Practice Location Address:
APT. 214
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-2960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-943-4385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2015

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: 106H00000X , with the licence number:  IMF 68556 , 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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