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1922805571 NPI number — TYKENO DUPREE MILES AS, AA

NPI Number: 1922805571
Health Care Provider/Practitioner: TYKENO DUPREE MILES AS, AA

Information about “1922805571” NPI (TYKENO DUPREE MILES AS, AA) exists in 1922805571 in HTML format HTML  |  1922805571 in plain Text format TXT  |  1922805571 in PDF (Portable Document Format) PDF  |  1922805571 in an XML format XML  formats.

NPI Number : 1922805571 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922805571",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MILES",
    "FirstName": "TYKENO",
    "MiddleName": "DUPREE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AS, AA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MILES",
    "OtherFirstName": "TYKENO",
    "OtherMiddleName": "DUPREE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DIRECT SUPPORT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2442 SANTA ANA N",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOS ANGELES",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "90059-2106",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "424-213-9143",
    "MailingAddressFaxNumber": "323-537-4295",
    "FirstLinePracticeLocationAddress": "2442 SANTA ANA N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOS ANGELES",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "90059-2106",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "424-213-9143",
    "PracticeLocationAddressFaxNumber": "323-537-4295",
    "EnumerationDate": "02/28/2025",
    "LastUpdateDate": "02/28/2025",
    "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": "251C00000X",
        "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
        "LicenseNumber": "6058246735",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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