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1154598019 NPI number — MARY HO-MONG BACH LOOD MD, PHARMD

NPI Number: 1154598019
Health Care Provider/Practitioner: MARY HO-MONG BACH LOOD MD, PHARMD

Information about “1154598019” NPI (MARY HO-MONG BACH LOOD MD, PHARMD) exists in 1154598019 in HTML format HTML  |  1154598019 in plain Text format TXT  |  1154598019 in PDF (Portable Document Format) PDF  |  1154598019 in an XML format XML  formats.

NPI Number : 1154598019 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154598019",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LOOD",
    "FirstName": "MARY",
    "MiddleName": "HO-MONG BACH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD, PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BACH",
    "OtherFirstName": "MARY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD, PHARMD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1601 E 4TH PLAIN BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VANCOUVER",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98661-3713",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-422-1145",
    "MailingAddressFaxNumber": "208-422-1038",
    "FirstLinePracticeLocationAddress": "1601 E 4TH PLAIN BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VANCOUVER",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98661-3713",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-422-1145",
    "PracticeLocationAddressFaxNumber": "208-422-1038",
    "EnumerationDate": "05/09/2008",
    "LastUpdateDate": "10/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RR0500X",
          "TaxonomyName": "Rheumatology Physician",
          "LicenseNumber": "MD60151466",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "MD60151466",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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