Provider Demographics
NPI:1558087973
Name:KIMANI, AMOS GICHEHA
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:GICHEHA
Last Name:KIMANI
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 1:10136 ELLENWOOD AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3077
Mailing Address - Country:US
Mailing Address - Phone:302-482-5863
Mailing Address - Fax:
Practice Address - Street 1:10136 ELLENWOOD AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3077
Practice Address - Country:US
Practice Address - Phone:302-482-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA686645164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse