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General NPI Number Information
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NPI Number | 1205636404
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Entity Type | Organization
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Legal Business Name | FAYA KUN
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 3925 N MARTIN L KING BLVD STE 102
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-7674
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Country | US
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Telephone | 323-866-9730
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Fax |
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Provider Business Mailing Address
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Address Line | 5790 WESTCHASE ST
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City | ATLANTA
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State | GA
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Zip | 30336-2919
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Country | US
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Telephone | 323-866-9730
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARQUEL MUHAMMAD
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Credential |
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Telephone | 323-866-9730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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