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1619937877 NPI number — THOMAS H VAN M.D.

NPI Number: 1619937877
Health Care Provider/Practitioner: THOMAS H VAN M.D.

Information about “1619937877” NPI (THOMAS H VAN M.D.) exists in 1619937877 in HTML format HTML  |  1619937877 in plain Text format TXT  |  1619937877 in PDF (Portable Document Format) PDF  |  1619937877 in an XML format XML  formats.

NPI Number : 1619937877 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619937877",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VAN",
    "FirstName": "THOMAS",
    "MiddleName": "H",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VAN",
    "OtherFirstName": "THINH",
    "OtherMiddleName": "H",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "440 E HUNTINGTON DR",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "ARCADIA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91006-3776",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "626-254-8246",
    "MailingAddressFaxNumber": "626-254-8236",
    "FirstLinePracticeLocationAddress": "2600 REDONDO AVE",
    "SecondLinePracticeLocationAddress": "303",
    "PracticeLocationAddressCityName": "LONG BEACH",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90806-2329",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "562-988-7000",
    "PracticeLocationAddressFaxNumber": "562-988-7201",
    "EnumerationDate": "03/23/2006",
    "LastUpdateDate": "01/15/2013",
    "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": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "A061189",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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