Provider Demographics
NPI:1437648029
Name:KINGORI, MAURINE MUTHONI
Entity Type:Individual
Prefix:
First Name:MAURINE
Middle Name:MUTHONI
Last Name:KINGORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF MEDICAL EDUCATION: MIAMI VALLEY HOSPITAL
Mailing Address - Street 2:1 WYOMING STREET
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-3844
Mailing Address - Fax:937-208-5393
Practice Address - Street 1:8260 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3707
Practice Address - Country:US
Practice Address - Phone:937-434-1708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH300256611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program