Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6779 | AZ |
N | 1223X0400X | Orthodontists | DE00010374 | WA |
NPI | 1023170107 |
---|---|
Provider Name | Kamal Alfakiani |
First Address | Tempe, AZ 85284-2200 |
Second Address | Chandler, AZ 85225-7164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 13/08/2007 |