Provider Demographics
NPI:1417738808
Name:KAYONDO, JOEL JUUKO I
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:JUUKO
Last Name:KAYONDO
Suffix:I
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 1:6125 S ASH AVE STE B-7
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5608
Mailing Address - Country:US
Mailing Address - Phone:928-255-6213
Mailing Address - Fax:
Practice Address - Street 1:6125 S ASH AVE STE B-7
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5608
Practice Address - Country:US
Practice Address - Phone:928-255-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator