Provider Demographics
NPI:1750358958
Name:JAKI MED INC
Entity type:Organization
Organization Name:JAKI MED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNAK
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-684-0097
Mailing Address - Street 1:609 INDIAN TRAIL RD S
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7682
Mailing Address - Country:US
Mailing Address - Phone:704-684-0097
Mailing Address - Fax:704-684-0490
Practice Address - Street 1:598 INDIAN TRAIL RD S
Practice Address - Street 2:SUITE 121
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8689
Practice Address - Country:US
Practice Address - Phone:704-684-0097
Practice Address - Fax:704-684-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies