Healthcare Provider Details

I. General information

NPI: 1750358958
Provider Name (Legal Business Name): JAKI MED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 INDIAN TRAIL RD S SUITE 121
INDIAN TRAIL NC
28079-8689
US

IV. Provider business mailing address

609 INDIAN TRAIL RD S
INDIAN TRAIL NC
28079-7682
US

V. Phone/Fax

Practice location:
  • Phone: 704-684-0097
  • Fax: 704-684-0490
Mailing address:
  • Phone: 704-684-0097
  • Fax: 704-684-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ARNAK IVANOV
Title or Position: PRESIDENT
Credential:
Phone: 704-684-0097