1306523543 NPI number — MR. CHIA KIRYAN WAIN

Table of content: MR. CHIA KIRYAN WAIN (NPI 1306523543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306523543 NPI number — MR. CHIA KIRYAN WAIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAIN
Provider First Name:
CHIA
Provider Middle Name:
KIRYAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1306523543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 S UNIVERSITY BLVD STE 2F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36609-7860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-340-2020
Provider Business Mailing Address Fax Number:
251-340-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 S UNIVERSITY BLVD STE 2F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-7860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-340-2020
Provider Business Practice Location Address Fax Number:
251-340-2020
Provider Enumeration Date:
06/29/2023

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: 106S00000X , with the licence number:  RBT-23-280617 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RBT-23-280617 . This is a "REGISTERED BEHAVIORAL TECHNICIAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".