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General NPI Number Information
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NPI Number | 1568852135
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Entity Type | Organization
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Legal Business Name | AKY MD LLC
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 2809 SW 119TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-2605
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Country | US
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Telephone | 405-757-7818
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 SW 119TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73170-2605
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Country | US
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Telephone | 405-757-7818
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEX YAFFE
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Credential |
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Telephone | 405-757-7818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 103749
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License Number State | OK
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