Provider Demographics
NPI:1093077182
Name:KAIRUKI, ALLAN K
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:K
Last Name:KAIRUKI
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 1:3421 TOLEDO TER
Mailing Address - Street 2:APT E2
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1958
Mailing Address - Country:US
Mailing Address - Phone:443-538-8770
Mailing Address - Fax:
Practice Address - Street 1:3421 TOLEDO TER
Practice Address - Street 2:APT E2
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1958
Practice Address - Country:US
Practice Address - Phone:443-538-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
K620051461174374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide