1992813406 NPI number — DR. KATHRYN CAROLIN AMIRIKIA MD, FACS

Table of content: DR. KATHRYN CAROLIN AMIRIKIA MD, FACS (NPI 1992813406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992813406 NPI number — DR. KATHRYN CAROLIN AMIRIKIA MD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMIRIKIA
Provider First Name:
KATHRYN
Provider Middle Name:
CAROLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FACS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAROLIN
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
ALICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, FACS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992813406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1737 CREEKSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLSOM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-932-0315
Provider Business Mailing Address Fax Number:
916-932-0003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1737 CREEKSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLSOM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-932-0315
Provider Business Practice Location Address Fax Number:
916-932-0312
Provider Enumeration Date:
08/25/2006

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: 208600000X , with the licence number:  4301061506 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: G86919 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: G86919 , 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: 943235612 . This is a "PEN MILLS SURG SPEC GRP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2612952 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383064919 . This is a "UNIV SURGEONS TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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