1952534208 NPI number — GULNORA KIYAMOVA II

Table of content: GULNORA KIYAMOVA II (NPI 1952534208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952534208 NPI number — GULNORA KIYAMOVA II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIYAMOVA
Provider First Name:
GULNORA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
F

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:
1952534208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1113 W 32ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-3728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-720-2171
Provider Business Mailing Address Fax Number:
907-272-7244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1113 W 32ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99503-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-720-2171
Provider Business Practice Location Address Fax Number:
907-272-7244
Provider Enumeration Date:
09/02/2009

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: 374U00000X , with the licence number:  933616 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 933616 . This is a "STATE OF ALASKA" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".