Provider Demographics
NPI:1164137378
Name:FOMBA, KINGSLEY NGOH
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:NGOH
Last Name:FOMBA
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 1:2312 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-3134
Mailing Address - Country:US
Mailing Address - Phone:513-580-2524
Mailing Address - Fax:
Practice Address - Street 1:2312 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-3134
Practice Address - Country:US
Practice Address - Phone:513-580-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health