Provider Demographics
NPI:1245591916
Name:DAKIN OTOLARYNGOLOGY LLC
Entity Type:Organization
Organization Name:DAKIN OTOLARYNGOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-1645
Mailing Address - Street 1:1270 ATTAKAPAS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6549
Mailing Address - Country:US
Mailing Address - Phone:337-942-1645
Mailing Address - Fax:337-942-1659
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-942-1645
Practice Address - Fax:337-942-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD021223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1694177Medicaid
LAD82488Medicare UPIN
LA1694177Medicaid