=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134872351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE STOP HEALTH SERVICE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2022
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6025 N. CICERO AVE.
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-985-7367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6025 N. CICERO AVE.
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 872-985-7367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FNU MIR SAJID ALI SUFIYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-500-7441
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------