Provider Demographics
NPI:1821766288
Name:TAJUDDIN, AMEEN (MBBS)
Entity Type:Individual
Prefix:
First Name:AMEEN
Middle Name:
Last Name:TAJUDDIN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 BROADWAY UNIT 609
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3527
Mailing Address - Country:US
Mailing Address - Phone:816-937-0122
Mailing Address - Fax:
Practice Address - Street 1:2288 W 36 AVE
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:KS
Practice Address - Zip Code:66103
Practice Address - Country:US
Practice Address - Phone:816-937-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-10794390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program