Provider Demographics
NPI:1386013654
Name:TMJ SLEEP THERAPY CENTRE OF SAN FRANCISCO
Entity Type:Organization
Organization Name:TMJ SLEEP THERAPY CENTRE OF SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,DABCP,DABCDSM
Authorized Official - Phone:415-226-7274
Mailing Address - Street 1:450 SUTTER ST RM 1708
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4101
Mailing Address - Country:US
Mailing Address - Phone:925-226-7274
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1708
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4101
Practice Address - Country:US
Practice Address - Phone:925-226-7274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46731305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization