MEDICARE: JAKI MED INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750358958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAKI MED INC

Provider Business Mailing Address
First Line	:	609 INDIAN TRAIL RD S
Second Line	:
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-7682
Country	:	US
Telephone Number	:	704-684-0097
Fax Number	:	704-684-0490

Provider Business Practice Location Address
First Line	:	598 INDIAN TRAIL RD S
Second Line	:	SUITE 121
City	:	INDIAN TRAIL
State	:	NC
Zip	:	28079-8689
Country	:	US
Telephone Number	:	704-684-0097
Fax Number	:	704-684-0490

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARNAK IVANOV
Credential	:
Telephone Number	:	704-684-0097

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/22/2020

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