Provider Demographics
NPI:1043943756
Name:KAKEMBO, ISMAIL J (BSC)
Entity Type:Individual
Prefix:
First Name:ISMAIL
Middle Name:J
Last Name:KAKEMBO
Suffix:
Gender:M
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17841 LASSEN ST APT 216
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4747
Mailing Address - Country:US
Mailing Address - Phone:347-981-5357
Mailing Address - Fax:
Practice Address - Street 1:17841 LASSEN ST APT 216
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4747
Practice Address - Country:US
Practice Address - Phone:347-981-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No344600000XTransportation ServicesTaxi