Provider Demographics
NPI:1407159858
Name:HIPPOCRATES SLEEP DISORDER DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:HIPPOCRATES SLEEP DISORDER DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:YEE
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:670-234-8005
Mailing Address - Street 1:1 NAURU LOOP DRIVE, 402 MARIANAS BUSINESS PLAZA
Mailing Address - Street 2:P.O. BOX 502213
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-2213
Mailing Address - Country:US
Mailing Address - Phone:670-234-8005
Mailing Address - Fax:670-234-8028
Practice Address - Street 1:1 NAURU LOOP DRIVE, 402 MARIANAS BUSINESS PLAZA
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-2213
Practice Address - Country:US
Practice Address - Phone:670-234-8005
Practice Address - Fax:670-234-8028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIPPOCRATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP1759500031261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic