Provider Demographics
NPI:1215392048
Name:YIMAM-KNFU, WODAJE SR
Entity Type:Individual
Prefix:
First Name:WODAJE
Middle Name:
Last Name:YIMAM-KNFU
Suffix:SR
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 1:34 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1212
Mailing Address - Country:US
Mailing Address - Phone:716-380-2230
Mailing Address - Fax:
Practice Address - Street 1:34 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1212
Practice Address - Country:US
Practice Address - Phone:716-380-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751658149172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver