Healthcare Provider Details

I. General information

NPI: 1407159858
Provider Name (Legal Business Name): HIPPOCRATES SLEEP DISORDER DIAGNOSTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NAURU LOOP DRIVE, 402 MARIANAS BUSINESS PLAZA
SAIPAN MP
96950-2213
US

IV. Provider business mailing address

1 NAURU LOOP DRIVE, 402 MARIANAS BUSINESS PLAZA P.O. BOX 502213
SAIPAN MP
96950-2213
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8005
  • Fax: 670-234-8028
Mailing address:
  • Phone: 670-234-8005
  • Fax: 670-234-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number1759500031
License Number StateMP

VIII. Authorized Official

Name: DR. JOHNNY YEE FONG
Title or Position: C.E.O.
Credential: M.D.
Phone: 670-234-8005