=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487434452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KJELD AAMODT DDS MS NY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2023
-----------------------------------------------------
Last Update Date | 10/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 W 19TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-955-1669
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 MARKET ST STE 1200
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94105-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-548-9145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COFOUNDER, CEO OF IMPRESS USA
-----------------------------------------------------
Name | KJELD AAMODT
-----------------------------------------------------
Credential | DDS MS
-----------------------------------------------------
Telephone | 831-238-7285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------