Provider Demographics
NPI:1417138884
Name:K STREET ORTHODONTIC GROUP, PC
Entity Type:Organization
Organization Name:K STREET ORTHODONTIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:SHOUHAYIB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS- MS
Authorized Official - Phone:202-775-0167
Mailing Address - Street 1:3 WASHINGTON CIR NW
Mailing Address - Street 2:SUITE #306
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2356
Mailing Address - Country:US
Mailing Address - Phone:202-775-0167
Mailing Address - Fax:202-775-8332
Practice Address - Street 1:3 WASHINGTON CIR NW
Practice Address - Street 2:SUITE #306
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2356
Practice Address - Country:US
Practice Address - Phone:202-775-0167
Practice Address - Fax:202-775-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN50381223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty