=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932671856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH COUNTY PAIN INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2018
-----------------------------------------------------
Last Update Date | 12/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 E VALLEY PKWY STE K
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 442-444-0537
-----------------------------------------------------
Fax | 760-466-9313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15725 BOWL CREEK RD
-----------------------------------------------------
City | POWAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92064-2044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 442-444-0537
-----------------------------------------------------
Fax | 760-888-2079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LENG KY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 951-675-0530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------