Healthcare Provider Details

I. General information

NPI: 1255856787
Provider Name (Legal Business Name): BAKYT KOZHOKEYEV
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W 10TH ST APT 6B
BROOKLYN NY
11223-1124
US

IV. Provider business mailing address

1602 W 10TH ST APT 6B
BROOKLYN NY
11223-1124
US

V. Phone/Fax

Practice location:
  • Phone: 646-331-2353
  • Fax:
Mailing address:
  • Phone: 646-331-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number703649-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: