MEDICARE: ASSYRIAN FAMILY HEALTH ALLIANCE

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1487254918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSYRIAN FAMILY HEALTH ALLIANCE

Provider Business Mailing Address
First Line	:	10210 N 32ND ST STE C7
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3826
Country	:	US
Telephone Number	:	602-675-1554
Fax Number	:	602-610-5844

Provider Business Practice Location Address
First Line	:	10210 N 32ND ST STE C6
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3826
Country	:	US
Telephone Number	:	602-675-1554
Fax Number	:	602-610-5844

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY JOSEPH YOUKHANA
Credential	:	PHARM D
Telephone Number	:	602-332-1123

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	12/03/2020

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