=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023222189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAFYIK HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16023 WILLIWAW DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77083-5375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-980-9491
-----------------------------------------------------
Fax | 713-776-1166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9898 BISSONNET ST SUITE 375 D
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-776-2266
-----------------------------------------------------
Fax | 713-776-1166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. IFEANYI DAVID ONYEKWENA
-----------------------------------------------------
Credential | BBA, MBA, MCSE
-----------------------------------------------------
Telephone | 713-776-2266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number | 0063435
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------