NPI Number: 1083218424
Health Care Provider/Practitioner: KITICHAI RUNGCHARASSAENG DDS, MS, AND HOWARD LEE, DMD, MS, INC
Information about “1083218424” NPI (KITICHAI RUNGCHARASSAENG DDS, MS, AND HOWARD LEE, DMD, MS, INC)
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<?xml version="1.0" encoding="UTF-8"?>
<Npi>
<NPI>
1083218424
</NPI>
<EntityType>
Organization
</EntityType>
<ReplacementNPI/>
<EIN/>
<IsSoleProprietor/>
<IsOrgSubpart>
N
</IsOrgSubpart>
<ParentOrgLBN/>
<ParentOrgTIN/>
<OrgName>
KITICHAI RUNGCHARASSAENG DDS, MS, AND HOWARD LEE, DMD, MS, INC
</OrgName>
<LastName/>
<FirstName/>
<MiddleName/>
<NamePrefix/>
<NameSuffix/>
<Credential/>
<OtherOrgName/>
<OtherOrgNameTypeCode/>
<OtherLastName/>
<OtherFirstName/>
<OtherMiddleName/>
<OtherNamePrefix/>
<OtherNameSuffix/>
<OtherCredential/>
<OtherLastNameTypeCode/>
<FirstLineMailingAddress>
540 W. BASELINE RD
</FirstLineMailingAddress>
<SecondLineMailingAddress>
STE 12
</SecondLineMailingAddress>
<MailingAddressCityName>
CLAREMONT
</MailingAddressCityName>
<MailingAddressStateName>
CA
</MailingAddressStateName>
<MailingAddressPostalCode>
91711
</MailingAddressPostalCode>
<MailingAddressCountryCode>
US
</MailingAddressCountryCode>
<MailingAddressTelephoneNumber>
909-626-8501
</MailingAddressTelephoneNumber>
<MailingAddressFaxNumber/>
<FirstLinePracticeLocationAddress>
540 W. BASELINE RD
</FirstLinePracticeLocationAddress>
<SecondLinePracticeLocationAddress>
STE 12
</SecondLinePracticeLocationAddress>
<PracticeLocationAddressCityName>
CLAREMONT
</PracticeLocationAddressCityName>
<PracticeLocationAddressStateName>
CA
</PracticeLocationAddressStateName>
<PracticeLocationAddressPostalCode>
91711
</PracticeLocationAddressPostalCode>
<PracticeLocationAddressCountryCode>
US
</PracticeLocationAddressCountryCode>
<PracticeLocationAddressTelephoneNumber>
909-626-8501
</PracticeLocationAddressTelephoneNumber>
<PracticeLocationAddressFaxNumber/>
<EnumerationDate>
11/25/2020
</EnumerationDate>
<LastUpdateDate>
11/25/2020
</LastUpdateDate>
<NPIDeactivationReasonCode/>
<NPIDeactivationReason/>
<NPIDeactivationDate/>
<NPIReactivationDate/>
<GenderCode/>
<Gender/>
<AuthorizedOfficialLastName>
UNG
</AuthorizedOfficialLastName>
<AuthorizedOfficialFirstName>
KERA
</AuthorizedOfficialFirstName>
<AuthorizedOfficialMiddleName/>
<AuthorizedOfficialTitle>
MEDICAL BILLER
</AuthorizedOfficialTitle>
<AuthorizedOfficialNamePrefix/>
<AuthorizedOfficialNameSuffix/>
<AuthorizedOfficialCredential/>
<AuthorizedOfficialTelephoneNumber>
626-460-0604
</AuthorizedOfficialTelephoneNumber>
<Taxonomies>
<Taxonomy>
<TaxonomyCode>
1223X0400X
</TaxonomyCode>
<TaxonomyName>
Orthodontics and Dentofacial Orthopedics Dentistry
</TaxonomyName>
<LicenseNumber/>
<LicenseNumberStateCode/>
<PrimaryTaxonomySwitch>
Y
</PrimaryTaxonomySwitch>
</Taxonomy>
</Taxonomies>
<HealthcareProviderTaxonomyGroups>
<HealthcareProviderTaxonomyGroup>
<HealthcareProviderTaxonomyGroupName>
193400000X SINGLE SPECIALTY GROUP
</HealthcareProviderTaxonomyGroupName>
<HealthcareProviderTaxonomyGroupDescription>
Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization.
</HealthcareProviderTaxonomyGroupDescription>
</HealthcareProviderTaxonomyGroup>
</HealthcareProviderTaxonomyGroups>
</Npi>
<?xml version="1.0" encoding="UTF-8"?>
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" elementFormDefault="qualified" attributeFormDefault="unqualified">
<xs:element name="Npi">
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<xs:element name="ParentOrgLBN"></xs:element>
<xs:element name="ParentOrgTIN"></xs:element>
<xs:element name="OrgName"></xs:element>
<xs:element name="LastName" type="xs:string"></xs:element>
<xs:element name="FirstName" type="xs:string"></xs:element>
<xs:element name="MiddleName"></xs:element>
<xs:element name="NamePrefix" type="xs:string"></xs:element>
<xs:element name="NameSuffix"></xs:element>
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<xs:element name="OtherFirstName"></xs:element>
<xs:element name="OtherMiddleName"></xs:element>
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<xs:element name="OtherCredential"></xs:element>
<xs:element name="OtherLastNameTypeCode"></xs:element>
<xs:element name="FirstLineMailingAddress" type="xs:string"></xs:element>
<xs:element name="SecondLineMailingAddress"></xs:element>
<xs:element name="MailingAddressCityName" type="xs:string"></xs:element>
<xs:element name="MailingAddressStateName" type="xs:string"></xs:element>
<xs:element name="MailingAddressPostalCode" type="xs:string"></xs:element>
<xs:element name="MailingAddressCountryCode" type="xs:string"></xs:element>
<xs:element name="MailingAddressTelephoneNumber" type="xs:string"></xs:element>
<xs:element name="MailingAddressFaxNumber"></xs:element>
<xs:element name="FirstLinePracticeLocationAddress" type="xs:string"></xs:element>
<xs:element name="SecondLinePracticeLocationAddress" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressCityName" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressStateName" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressPostalCode" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressCountryCode" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressTelephoneNumber" type="xs:string"></xs:element>
<xs:element name="PracticeLocationAddressFaxNumber"></xs:element>
<xs:element name="EnumerationDate" type="xs:string"></xs:element>
<xs:element name="LastUpdateDate" type="xs:string"></xs:element>
<xs:element name="NPIDeactivationReasonCode"></xs:element>
<xs:element name="NPIDeactivationReason"></xs:element>
<xs:element name="NPIDeactivationDate"></xs:element>
<xs:element name="NPIReactivationDate"></xs:element>
<xs:element name="GenderCode" type="xs:string"></xs:element>
<xs:element name="Gender" type="xs:string"></xs:element>
<xs:element name="AuthorizedOfficialLastName"></xs:element>
<xs:element name="AuthorizedOfficialFirstName"></xs:element>
<xs:element name="AuthorizedOfficialMiddleName"></xs:element>
<xs:element name="AuthorizedOfficialTitle"></xs:element>
<xs:element name="AuthorizedOfficialNamePrefix"></xs:element>
<xs:element name="AuthorizedOfficialNameSuffix"></xs:element>
<xs:element name="AuthorizedOfficialCredential"></xs:element>
<xs:element name="AuthorizedOfficialTelephoneNumber"></xs:element>
<xs:element name="Taxonomies">
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<xs:element name="Taxonomy" maxOccurs="unbounded">
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<xs:element name="TaxonomyCode" type="xs:string"></xs:element>
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<xs:element name="LicenseNumber" type="xs:string"></xs:element>
<xs:element name="LicenseNumberStateCode" type="xs:string"></xs:element>
<xs:element name="PrimaryTaxonomySwitch" type="xs:string"></xs:element>
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<xs:element name="OtherIdentifier" maxOccurs="unbounded">
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<xs:element name="OtherIdentifierName" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierType" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierState" type="xs:string"></xs:element>
<xs:element name="OtherIdentifierIssuer"></xs:element>
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</xs:element>
<xs:element name="HealthcareProviderTaxonomyGroups"></xs:element>
</xs:sequence>
</xs:complexType>
</xs:element>
</xs:schema>