Provider Demographics
NPI:1275061467
Name:AYANDEH HEALTH LLC
Entity Type:Organization
Organization Name:AYANDEH HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARRASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-412-1404
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1115
Mailing Address - Country:US
Mailing Address - Phone:405-659-5656
Mailing Address - Fax:405-701-5421
Practice Address - Street 1:7 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439
Practice Address - Country:US
Practice Address - Phone:405-659-5656
Practice Address - Fax:405-659-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
OK363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty