O Longevity & Wellness, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5305 Issued in AZ

Legal business name

O LONGEVITY & WELLNESS, PLLC

Practice address

9821 N 95TH St Ste 101
Scottsdale, AZ 85258-4589

Phone

(480) 416-0403

Fax

(480) 240-5467

NPI assigned

Apr 12, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ken Shadman Ota, DO

Title

Physician

Phone

(480) 365-8035

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567123200000",
    "number": "1083111371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9821 N 95TH ST STE 101",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584589",
            "telephone_number": "480-365-8035",
            "fax_number": "480-718-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9821 N 95TH ST STE 101",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584589",
            "telephone_number": "480-416-0403",
            "fax_number": "480-240-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O LONGEVITY & WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-12",
        "last_updated": "2019-08-30",
        "status": "A",
        "authorized_official_last_name": "OTA",
        "authorized_official_first_name": "KEN",
        "authorized_official_middle_name": "SHADMAN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "480-365-8035",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "5305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.