Healthcare Provider Details

I. General information

NPI: 1295924454
Provider Name (Legal Business Name): ZEINA A.W. DAJANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E 9TH AVE STE 640
DENVER CO
80220-3925
US

IV. Provider business mailing address

1938 S GILPIN ST
DENVER CO
80210-3308
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-2008
  • Fax: 303-351-7893
Mailing address:
  • Phone: 612-743-7970
  • Fax: 303-351-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number55257
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number55257
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57013167
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0054253
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57.013167
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: