Provider Demographics
NPI:1528464294
Name:MIKWAN CORPORATION
Entity type:Organization
Organization Name:MIKWAN CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-289-9968
Mailing Address - Street 1:15830 RAWHIDE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9521
Mailing Address - Country:US
Mailing Address - Phone:818-808-5810
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE
Practice Address - Street 2:SUITE 290-295
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4269
Practice Address - Country:US
Practice Address - Phone:951-289-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health