1568443562 NPI number — KOUROSH JAFARNIA MD

Table of content: KOUROSH JAFARNIA MD (NPI 1568443562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568443562 NPI number — KOUROSH JAFARNIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAFARNIA
Provider First Name:
KOUROSH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JAFARNIA
Provider Other First Name:
KORSH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568443562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13802 CENTERFIELD DR
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-6044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-737-0999
Provider Business Mailing Address Fax Number:
281-737-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13802 CENTERFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-6044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-737-0999
Provider Business Practice Location Address Fax Number:
281-737-0926
Provider Enumeration Date:
11/08/2005

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: 207X00000X , with the licence number:  K7171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: K7171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 153386104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DY922 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1568443562 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00904735 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153386103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153386102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01070532 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com