1093866303 NPI number — KAMAL HOKAN MD

Table of content: KAMAL HOKAN MD (NPI 1093866303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093866303 NPI number — KAMAL HOKAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOKAN
Provider First Name:
KAMAL
Provider Middle Name:
Provider Name Prefix Text:
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:
1093866303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
785 OHIO AVE
Provider Second Line Business Mailing Address:
STE 2C
Provider Business Mailing Address City Name:
CLARKSDALE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38614-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-627-2544
Provider Business Mailing Address Fax Number:
662-627-2052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
785 OHIO AVE
Provider Second Line Business Practice Location Address:
STE 2C
Provider Business Practice Location Address City Name:
CLARKSDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38614-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-627-2544
Provider Business Practice Location Address Fax Number:
662-627-2052
Provider Enumeration Date:
01/15/2007

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: 2084N0400X , with the licence number:  4301072133 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 22982 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 22982 . This is a "MS LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 201335550 . This is a "TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: KH072133 . This is a "STATE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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