Provider Demographics
NPI:1477184521
Name:LUNDENGA, KEIKO L
Entity Type:Individual
Prefix:
First Name:KEIKO
Middle Name:L
Last Name:LUNDENGA
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 1:146 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-2144
Mailing Address - Country:US
Mailing Address - Phone:757-277-4925
Mailing Address - Fax:
Practice Address - Street 1:6400 E BROAD ST FL 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2086
Practice Address - Country:US
Practice Address - Phone:614-655-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1477184521Medicaid