Provider Demographics
NPI:1356850473
Name:SIH MOKAN, P.C.
Entity type:Organization
Organization Name:SIH MOKAN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:TULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-400-4142
Mailing Address - Street 1:803 W 48TH ST APT 404
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1859
Mailing Address - Country:US
Mailing Address - Phone:561-400-4142
Mailing Address - Fax:
Practice Address - Street 1:803 W 48TH ST APT 404
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1859
Practice Address - Country:US
Practice Address - Phone:561-400-4142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental