Provider Demographics
NPI:1194583575
Name:IA LLC
Entity type:Organization
Organization Name:IA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HWASOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:401-363-2445
Mailing Address - Street 1:1050 MAIN ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3163
Mailing Address - Country:US
Mailing Address - Phone:401-363-2445
Mailing Address - Fax:401-371-4418
Practice Address - Street 1:1050 MAIN ST UNIT 15
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3163
Practice Address - Country:US
Practice Address - Phone:401-363-2445
Practice Address - Fax:401-371-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center