1316198302 NPI number — KHADJENOURY LLC

Table of content: (NPI 1316198302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316198302 NPI number — KHADJENOURY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHADJENOURY LLC
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:
6
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:
1316198302
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8848 WILLOW HILLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84093-1889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-907-6890
Provider Business Mailing Address Fax Number:
801-944-2940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HC 61, BOX D
Provider Second Line Business Practice Location Address:
EDVENTURES PROGRAM C/O LEUPP SCHOOLS INC
Provider Business Practice Location Address City Name:
LEUPP
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-907-6890
Provider Business Practice Location Address Fax Number:
801-944-2940
Provider Enumeration Date:
10/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KHADJENOURY
Authorized Official First Name:
SIAMAK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
520-907-6890

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com