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General NPI Number Information
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NPI Number | 1669253571
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Entity Type | Organization
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Legal Business Name | RJK MEDICAL
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 7077 E BELL RD SUITE 200 OFFICE 101
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-8525
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Country | US
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Telephone | 480-757-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 10448 E PENSTAMIN DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-2446
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Country | US
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Telephone | 313-587-7228
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDY KAUK
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Credential | APRN
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Telephone | 313-587-7228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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