=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003517327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN TAI TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2023
-----------------------------------------------------
Last Update Date | 03/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1652 E DETROIT ST
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-5216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-373-4960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1652 E DETROIT ST
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85225-5216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-373-4960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TARIG I ELKHALIFA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-373-4960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------