MEDICARE: FAYA KUN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205636404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYA KUN

Provider Business Mailing Address
First Line	:	5790 WESTCHASE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30336-2919
Country	:	US
Telephone Number	:	323-866-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 N MARTIN L KING BLVD STE 102
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-7674
Country	:	US
Telephone Number	:	323-866-9730
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DARQUEL MUHAMMAD
Credential	:
Telephone Number	:	323-866-9730

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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Directions to “FAYA KUN ” Practice Location

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