Healthcare Provider Details

I. General information

NPI: 1568852135
Provider Name (Legal Business Name): AKY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 SW 119TH ST
OKLAHOMA CITY OK
73170-2605
US

IV. Provider business mailing address

2809 SW 119TH ST
OKLAHOMA CITY OK
73170-2605
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-7818
  • Fax:
Mailing address:
  • Phone: 405-757-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number103749
License Number StateOK

VIII. Authorized Official

Name: ALEX YAFFE
Title or Position: CEO
Credential:
Phone: 405-757-7818