1619576113 NPI number — CVJV ENTERPRISE CORP

Table of content: DR. ASHKAN FAHANDEJ SAADI DMD (NPI 1770711707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619576113 NPI number — CVJV ENTERPRISE CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CVJV ENTERPRISE CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1619576113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6941 NW 107TH CT # 100J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-3652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-393-4163
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8180 NW 36TH ST STE 100J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166-6650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-393-4163
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERA
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
ANDRES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-393-4163

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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