Provider Demographics
NPI:1407471337
Name:DWOMOH, YAW
Entity Type:Individual
Prefix:MR
First Name:YAW
Middle Name:
Last Name:DWOMOH
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 1:1718 HOLLOW CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-5517
Mailing Address - Country:US
Mailing Address - Phone:469-499-7762
Mailing Address - Fax:
Practice Address - Street 1:1718 HOLLOW CREEK CT
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-5517
Practice Address - Country:US
Practice Address - Phone:469-499-7762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311896164X00000X
253Z00000X, 376J00000X, 376K00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123456OtherCERTIFIED HOME HEALTH CARE, PAS