1295819985 NPI number — DR. HAIK G KAVOOKJIAN MD

Table of content: DR. HAIK G KAVOOKJIAN MD (NPI 1295819985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295819985 NPI number — DR. HAIK G KAVOOKJIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAVOOKJIAN
Provider First Name:
HAIK
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295819985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 NEWFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06905-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-358-0661
Provider Business Mailing Address Fax Number:
203-358-8619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 NEWFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06905-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-358-0661
Provider Business Practice Location Address Fax Number:
203-358-8619
Provider Enumeration Date:
10/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  033609 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)