Provider Demographics
NPI:1306414529
Name:MJKD ENTERPRISES LLC
Entity Type:Organization
Organization Name:MJKD ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD-HESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKBARIAN-TEFAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-209-9239
Mailing Address - Street 1:755 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1629
Practice Address - Country:US
Practice Address - Phone:210-209-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty