Healthcare Provider Details

I. General information

NPI: 1649248725
Provider Name (Legal Business Name): NATARAJAN ASOKAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3931 STOCKTON HILL RD SUITE D
KINGMAN AZ
86409-2426
US

IV. Provider business mailing address

3931 STOCKTON HILL RD SUITE D
KINGMAN AZ
86409-2426
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-5800
  • Fax: 928-681-5801
Mailing address:
  • Phone: 928-681-5800
  • Fax: 928-681-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number23270
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: