Provider Demographics
NPI:1396430351
Name:DIMOV, IVAN PETROV
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:PETROV
Last Name:DIMOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 WESTVIEW CRESCENT
Mailing Address - Street 2:
Mailing Address - City:NORTH VANCOUVER
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V7N3Y1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program