Healthcare Provider Details

I. General information

NPI: 1750697504
Provider Name (Legal Business Name): ZIZI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US

IV. Provider business mailing address

4012 S RAINBOW BLVD STE K320
LAS VEGAS NV
89103-2010
US

V. Phone/Fax

Practice location:
  • Phone: 888-217-8345
  • Fax:
Mailing address:
  • Phone: 888-217-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number21D0220588
License Number StateMD

VIII. Authorized Official

Name: SOM THOUMMANY
Title or Position: PRESIDENT
Credential:
Phone: 888-217-8345