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1104967876 NPI number — BENNY K.P. FAN D.O.

NPI Number: 1104967876
Health Care Provider/Practitioner: BENNY K.P. FAN D.O.

Information about “1104967876” NPI (BENNY K.P. FAN D.O.) exists in 1104967876 in HTML format HTML  |  1104967876 in plain Text format TXT  |  1104967876 in PDF (Portable Document Format) PDF  |  1104967876 in an XML format XML  formats.

NPI Number : 1104967876 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104967876",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FAN",
    "FirstName": "BENNY",
    "MiddleName": "K.P.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.O.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FAN",
    "OtherFirstName": "BENNY",
    "OtherMiddleName": "K.P.",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1450 AALA ST",
    "SecondLineMailingAddress": "APT#1203",
    "MailingAddressCityName": "HONOLULU",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96817-3604",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-537-1416",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "305 ROYAL HAWAIIAN AVE",
    "SecondLinePracticeLocationAddress": "SUITE307",
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96815-2526",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-924-9988",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/08/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171100000X",
        "TaxonomyName": "Acupuncturist",
        "LicenseNumber": "23",
        "LicenseNumberStateCode": "HI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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