Provider Demographics
NPI:1376532861
Name:FORCE HEALTH PROTECTION 18TH MEDBN
Entity Type:Organization
Organization Name:FORCE HEALTH PROTECTION 18TH MEDBN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL HEALTH NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:KYOUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLTUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-732-7396
Mailing Address - Street 1:A CO 168TH MED BN(AS)
Mailing Address - Street 2:UNIT# 15342
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96258-5342
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:A CO 168TH MED BN(AS)
Practice Address - Street 2:UNIT# 15342
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96258-5342
Practice Address - Country:KR
Practice Address - Phone:310-732-7059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital