Provider Demographics
NPI:1588718829
Name:KAZAK ENTERPRISES, INC.
Entity type:Organization
Organization Name:KAZAK ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-947-6099
Mailing Address - Street 1:1147 ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4401
Mailing Address - Country:US
Mailing Address - Phone:925-947-6099
Mailing Address - Fax:925-947-6624
Practice Address - Street 1:1147 ALPINE RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4401
Practice Address - Country:US
Practice Address - Phone:925-947-6099
Practice Address - Fax:925-947-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5873710001Medicare NSC