MEDICARE: DR. GYULNARA KYAZIMOVA

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	048370	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	:	1841279544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GYULNARA KYAZIMOVA

Provider Business Mailing Address
First Line	:	4414 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 MERMAID AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-2508
Country	:	US
Telephone Number	:	718-333-1991
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	10/01/2013

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