NPIMap

Organization Active NPI

Lodi Plaza Head & Neck Medical Assoc Inc

  • Otolaryngology Physician
  • Lodi, CA
National Provider Identifier
1669405668
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A71527 Issued in CA
Legal business name
LODI PLAZA HEAD & NECK MEDICAL ASSOC INC
Practice address
999 S Fairmont Ave
#215
Lodi, CA 95240
Phone
(209) 333-8510
Fax
(209) 333-0966
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Andrew Jungwook Limb, MDNPI 1952488512
Title
Ceo
Phone
(209) 333-8510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X G36674 CA
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X G80925 CA
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X A71527 CA Primary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X A64328 CA

Addresses

Primary practice location

999 S Fairmont Ave
#215
Lodi, CA 95240

Mailing address

999 S Fairmont Ave
#215
Lodi, CA 95240
Phone (209) 333-8510

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669405668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "#215",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95240",
            "telephone_number": "209-333-8510",
            "fax_number": "209-333-0966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 S FAIRMONT AVE",
            "address_2": "#215",
            "city": "LODI",
            "state": "CA",
            "postal_code": "95240",
            "telephone_number": "209-333-8510",
            "fax_number": "209-333-0966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LODI PLAZA HEAD & NECK MEDICAL ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIMB",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JUNGWOOK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-333-8510",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G36674",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G80925",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A71527",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A64328",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lodi, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.