Active NPI
Mamun Dewan
- Driver
- Glendale, AZ
National Provider Identifier
1063195071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 347741107
- Practice address
- 6014 N 67TH Ave
Glendale, AZ 85301-4902 - Phone
- (602) 299-1999
- NPI assigned
- Aug 8, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 347741107 | NY | Primary |
Addresses
Primary practice location
6014 N 67TH Ave
Glendale, AZ 85301-4902
Mailing address
6014 N 67TH Ave
Glendale, AZ 85301-4902
Phone (602) 299-1999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 347741107 | NY | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691452800000",
"number": "1063195071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6014 N 67TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853014902",
"telephone_number": "602-299-1999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6014 N 67TH AVE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853014902",
"telephone_number": "602-299-1999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWAN",
"first_name": "MAMUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-08",
"last_updated": "2023-08-08",
"certification_date": "2023-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NY",
"license": "347741107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.