Daziah LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

DAZIAH LLC

Practice address

130 Hayden Lake Rd E
Champlin, MN 55316-1411

Phone

(763) 221-8823

NPI assigned

Jan 19, 2024

Last updated

Jan 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Yushica Kelly

Title

Owner

Phone

(763) 221-8823

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1386405165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HAYDEN LAKE RD E",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HAYDEN LAKE RD E",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553161411",
            "telephone_number": "763-221-8823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAZIAH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "YUSHICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-221-8823"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Maureen Coyne
• Jan Marie D'Ambrosio, MA, LMFT
• Iyanu Mary Daramola
• Matthew Darnold
• Shelly Marie Davenport, MS, LMFT
• Daziah LLC
• Dental Specialists of Minnesota, PLLC (The Dental Specialists)
• Dentalign, PA (TC Orthodontics)
• Pandora Bazen Dickson
• Tibli Olandrus Dickson, MANAGER

• Case Management Agency in Champlin, MN
• Providers in Champlin, MN by specialty
• Case Management Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; 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.