1972959898 NPI number — DOCS FOR(4) KIDS MEDICAL OFFICE

Table of content: (NPI 1972959898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972959898 NPI number — DOCS FOR(4) KIDS MEDICAL OFFICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCS FOR(4) KIDS MEDICAL OFFICE
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:
HITESH D PATEL/SANGEETA H PATEL,MDS
Provider Other Organization Name Type Code:
3
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:
1972959898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13372 NEWPORT AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
TUSTIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92780-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-544-3430
Provider Business Mailing Address Fax Number:
714-573-8330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13372 NEWPORT AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
TUSTIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92780-3426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-544-3430
Provider Business Practice Location Address Fax Number:
714-573-8330
Provider Enumeration Date:
05/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
SANGEETA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-544-3430

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  A49867 , 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: 00A49867 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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