Healthcare Provider Details

I. General information

NPI: 1770119539
Provider Name (Legal Business Name): CLEVELAND SLEEP TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3736 ROCKY RIVER DR
CLEVELAND OH
44111-4050
US

IV. Provider business mailing address

3736 ROCKY RIVER DR
CLEVELAND OH
44111-4050
US

V. Phone/Fax

Practice location:
  • Phone: 440-552-5627
  • Fax:
Mailing address:
  • Phone: 440-552-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BENEDICT KIM
Title or Position: OWNER
Credential: DDS
Phone: 440-552-5627