Provider Demographics
NPI:1053081588
Name:BUABENG FAMILY LLC
Entity Type:Organization
Organization Name:BUABENG FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUBENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-373-3551
Mailing Address - Street 1:7423 PICARDY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4362
Mailing Address - Country:US
Mailing Address - Phone:225-228-2564
Mailing Address - Fax:
Practice Address - Street 1:7423 PICARDY AVE STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4362
Practice Address - Country:US
Practice Address - Phone:225-228-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA305542OtherMEDICAL BOARD