Provider Demographics
NPI:1235849977
Name:KIGENYI, AMOS
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:
Last Name:KIGENYI
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 1:4714 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7246
Mailing Address - Country:US
Mailing Address - Phone:310-894-3106
Mailing Address - Fax:
Practice Address - Street 1:4714 S OAK ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7246
Practice Address - Country:US
Practice Address - Phone:310-894-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health