Provider Demographics
NPI:1225625254
Name:AL KINANI, SAMO
Entity Type:Individual
Prefix:
First Name:SAMO
Middle Name:
Last Name:AL KINANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KINANI
Other - Middle Name:
Other - Last Name:EXPRESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OWNER/MANAGER
Mailing Address - Street 1:9715 MILL PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5607
Mailing Address - Country:US
Mailing Address - Phone:210-639-9933
Mailing Address - Fax:
Practice Address - Street 1:9715 MILL PATH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5607
Practice Address - Country:US
Practice Address - Phone:210-639-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMVV7017347C00000X
TX347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle