1134502859 NPI number — JABOU KINTEH II

Table of content: JABOU KINTEH II (NPI 1134502859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134502859 NPI number — JABOU KINTEH II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINTEH
Provider First Name:
JABOU
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KINTEH
Provider Other First Name:
JABOU
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134502859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1294 S TROY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80012-4420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
01294 S TROY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
NONE
Provider Business Practice Location Address Postal Code:
80012
Provider Business Practice Location Address Country Code:
GM
Provider Business Practice Location Address Telephone Number:
220-999-8425
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2015

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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