Provider Demographics
NPI:1598203978
Name:KAZAKK LLC
Entity Type:Organization
Organization Name:KAZAKK LLC
Other - Org Name:WHITE COAT 2 YOU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-277-6724
Mailing Address - Street 1:7866 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1944
Mailing Address - Country:US
Mailing Address - Phone:702-277-6724
Mailing Address - Fax:888-291-9747
Practice Address - Street 1:7866 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1944
Practice Address - Country:US
Practice Address - Phone:702-277-6724
Practice Address - Fax:888-291-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty