1801923800 NPI number — YEHIA IMAM, DDS PC

Table of content: (NPI 1801923800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801923800 NPI number — YEHIA IMAM, DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YEHIA IMAM, DDS PC
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:
1801923800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4939 W. RAY RD.
Provider Second Line Business Mailing Address:
4321
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85226-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-775-8056
Provider Business Mailing Address Fax Number:
480-775-8064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2034 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-775-8056
Provider Business Practice Location Address Fax Number:
480-775-8064
Provider Enumeration Date:
02/27/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
IMAM
Authorized Official First Name:
YEHIA
Authorized Official Middle Name:
ALY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-775-8056

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D3255 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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