1790097418 NPI number — DR. KARIM MANJI DPM

Table of content: DR. KARIM MANJI DPM (NPI 1790097418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790097418 NPI number — DR. KARIM MANJI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANJI
Provider First Name:
KARIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1790097418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 ARCH DRIVE
Provider Second Line Business Mailing Address:
#425
Provider Business Mailing Address City Name:
STUDIO CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-440-1774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 ARCH DR
Provider Second Line Business Practice Location Address:
#425
Provider Business Practice Location Address City Name:
STUDIO CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91604-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-440-1774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2010

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: 213ES0103X , with the licence number:  EL1820 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: TF693985 . This is a "DMV OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".