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General NPI Number Information
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NPI Number | 1881160018
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Entity Type | Organization
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Legal Business Name | AVICENNAS GROUP INC
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 814 MISSION ST FL 6
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-3018
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Country | US
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Telephone | 415-323-4937
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Fax | 415-358-8640
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Provider Business Mailing Address
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Address Line | 814 MISSION ST FL 6
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-3018
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Country | US
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Telephone | 415-323-4937
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Fax | 415-358-8640
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | YANG SONG
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Credential |
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Telephone | 415-323-4937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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