MEDICARE: DR. JAHANGIR IRYAMI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	050347-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144428178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAHANGIR IRYAMI

Provider Business Mailing Address
First Line	:	125-10 QUEENS BLVD
Second Line	:	1202
City	:	KEW GARDEN
State	:	NY
Zip	:	11405
Country	:	US
Telephone Number	:	718-827-6001
Fax Number	:	718-277-3938

Provider Business Practice Location Address
First Line	:	1176 LIBERTY AVE
Second Line	:	2FL
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3309
Country	:	US
Telephone Number	:	718-827-6001
Fax Number	:	718-277-3938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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