Provider Demographics
NPI:1841974938
Name:MAYEN, AJAK (MD)
Entity type:Individual
Prefix:
First Name:AJAK
Middle Name:
Last Name:MAYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 SE HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9689
Mailing Address - Country:US
Mailing Address - Phone:515-639-1933
Mailing Address - Fax:
Practice Address - Street 1:2055 KIMBALL AVE STE 101
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5047
Practice Address - Country:US
Practice Address - Phone:319-272-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-12883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine