Provider Demographics
NPI:1104153279
Name:US COAST GUARD
Entity type:Organization
Organization Name:US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN,
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-437-3688
Mailing Address - Street 1:91-1035 KAI LOLI STREET
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:501-437-3981
Mailing Address - Fax:
Practice Address - Street 1:USCGC MORGENTHAU
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96672-3916
Practice Address - Country:US
Practice Address - Phone:501-437-3981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2008333261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center