=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477667020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALI ALEM DENTAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 06/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2440 M STREET NW #608
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-822-3785
-----------------------------------------------------
Fax | 202-822-9096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2440 M STREET NW #608
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-822-3785
-----------------------------------------------------
Fax | 202-822-9096
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF AADC
-----------------------------------------------------
Name | DR. KIANOUSH ALEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-822-3785
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 4802
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------