Provider Demographics
NPI:1063846699
Name:AKY MD, LLC
Entity Type:Organization
Organization Name:AKY MD, LLC
Other - Org Name:JUST KIDS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE AND MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:YAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-757-7818
Mailing Address - Street 1:PO BOX 891625
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-1625
Mailing Address - Country:US
Mailing Address - Phone:405-757-7818
Mailing Address - Fax:888-673-6461
Practice Address - Street 1:400 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5833
Practice Address - Country:US
Practice Address - Phone:405-757-7818
Practice Address - Fax:405-703-0645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKY, MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-30
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200509800AMedicaid
OK200509800DMedicaid
OK200509800BMedicaid
OK200509800CMedicaid