NPI |
1083248926 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Last Name Legal Name |
CHU |
The first name of the authorized official. |
Provider First Name |
KRISTEEN |
The title or position of the authorized official. |
Provider First Line Business Practice Location Address |
313 S LAKEWOOD DR |
The 10-position telephone number of the authorized official. |
Provider Business Practice Location Address City Name |
BRANDON |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address State Name |
FL |
|
Provider Business Practice Location Address Postal Code |
335112815 |
|
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
7606875705 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
3/1/2020 |
|
Last Update Date |
3/1/2020 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
390200000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
CA |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
3/1/2020 |
|