1407004591 NPI number — DR. KATHLEEN A CHASE DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407004591 NPI number — DR. KATHLEEN A CHASE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHASE
Provider First Name:
KATHLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGRATH
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407004591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2930 2ND AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARINA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93933-6244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-582-2100
Provider Business Mailing Address Fax Number:
831-886-1529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 2ND AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARINA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93933-6244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-582-2100
Provider Business Practice Location Address Fax Number:
831-886-1529
Provider Enumeration Date:
09/03/2008

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:  OS10174 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 47853 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 20A18566 , 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: 020252 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 68587244 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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