Provider Demographics
NPI:1073066981
Name:AMOAKO, KWAME
Entity Type:Individual
Prefix:
First Name:KWAME
Middle Name:
Last Name:AMOAKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 BALINESE CT
Mailing Address - Street 2:
Mailing Address - City:LEONA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4482
Mailing Address - Country:US
Mailing Address - Phone:818-485-0868
Mailing Address - Fax:
Practice Address - Street 1:14659 OLIVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1652
Practice Address - Country:US
Practice Address - Phone:818-485-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide