1598996043 NPI number — MS. DORINDA AMUN KING-ADEKUNLE D.P.M

Table of content: MS. DORINDA AMUN KING-ADEKUNLE D.P.M (NPI 1598996043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598996043 NPI number — MS. DORINDA AMUN KING-ADEKUNLE D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING-ADEKUNLE
Provider First Name:
DORINDA
Provider Middle Name:
AMUN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KING
Provider Other First Name:
DORINDA
Provider Other Middle Name:
AMUN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598996043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HARRISON STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10550-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-563-2766
Provider Business Mailing Address Fax Number:
914-667-0797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 MEETING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29169-7535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-796-6900
Provider Business Practice Location Address Fax Number:
727-669-8417
Provider Enumeration Date:
07/31/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N006239-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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