Provider Demographics
NPI:1053749333
Name:LK DABIRI MEDICAL PC
Entity type:Organization
Organization Name:LK DABIRI MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:IRUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-353-7073
Mailing Address - Street 1:1220 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3832
Mailing Address - Country:US
Mailing Address - Phone:347-417-9733
Mailing Address - Fax:347-627-6800
Practice Address - Street 1:1220 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3832
Practice Address - Country:US
Practice Address - Phone:347-417-9733
Practice Address - Fax:347-627-6800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty