Provider Demographics
NPI:1326354333
Name:NINAK INC
Entity Type:Organization
Organization Name:NINAK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIRAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:248-252-5314
Mailing Address - Street 1:23371 MULHOLLAND DR # 327
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2734
Mailing Address - Country:US
Mailing Address - Phone:248-525-5314
Mailing Address - Fax:877-353-2634
Practice Address - Street 1:1916 EVANS AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3716
Practice Address - Country:US
Practice Address - Phone:248-525-5314
Practice Address - Fax:877-353-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYW306535291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY291U00000XMedicare UPIN