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General NPI Number Information
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NPI Number | 1215689757
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Entity Type | Organization
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Legal Business Name | DR K PRIMARY CARE, LLC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 3801 WOODBRIAR TRL
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City | PORT ORANGE
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State | FL
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Zip | 32129-9627
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Country | US
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Telephone | 386-382-7177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 612
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32170-0612
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Country | US
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Telephone | 386-382-7177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMIRA KARAKOSSIAN
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Credential | MD
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Telephone | 386-382-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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