Provider Demographics
NPI:1700899333
Name:KNIGHT STAR INC
Entity type:Organization
Organization Name:KNIGHT STAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAILEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGOCHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-817-4392
Mailing Address - Street 1:16782 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4202
Mailing Address - Country:US
Mailing Address - Phone:305-817-4392
Mailing Address - Fax:305-817-4396
Practice Address - Street 1:16782 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4202
Practice Address - Country:US
Practice Address - Phone:305-817-4392
Practice Address - Fax:305-817-4392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty