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General NPI Number Information
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NPI Number | 1033551932
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Entity Type | Organization
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Legal Business Name | KINGS MEDICAL SUITE, PC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 1725 E 12TH ST STE 301
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City | BROOKLYN
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State | NY
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Zip | 11229-1068
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Country | US
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Telephone | 718-336-1909
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Fax | 718-336-1929
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Provider Business Mailing Address
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Address Line | 1725 E 12TH ST STE 301
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City | BROOKLYN
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State | NY
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Zip | 11229-1068
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Country | US
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Telephone | 718-336-1909
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Fax | 718-336-1929
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KAMILA AGAYEVA
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Credential | M.D.
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Telephone | 718-336-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AAAASF # 3833
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License Number State | NY
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