1972681195 NPI number — AGELESS HOME HEALTH CARE

Table of content: DR. DANIEL ROBERT KING D.D.S. (NPI 1225056526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972681195 NPI number — AGELESS HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGELESS HOME HEALTH CARE
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:
1972681195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94401-0847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-921-1554
Provider Business Mailing Address Fax Number:
800-571-1474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 DE SABLA RD
Provider Second Line Business Practice Location Address:
UNIT 1101
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94402-1273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-921-1554
Provider Business Practice Location Address Fax Number:
800-571-1474
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LI
Authorized Official First Name:
FENG
Authorized Official Middle Name:
ZHAN
Authorized Official Title or Position:
OWNER/CASE MANAGER
Authorized Official Telephone Number:
650-921-1554

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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