Provider Demographics
NPI:1598303448
Name:KADOMO, NTEZIRYAYO
Entity Type:Individual
Prefix:
First Name:NTEZIRYAYO
Middle Name:
Last Name:KADOMO
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 1:1601 ORLEANS CIR APT 2F
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-4904
Mailing Address - Country:US
Mailing Address - Phone:816-933-7211
Mailing Address - Fax:
Practice Address - Street 1:1601 ORLEANS CIR APT 2F
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-4904
Practice Address - Country:US
Practice Address - Phone:816-933-7211
Practice Address - Fax:816-817-2222
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOVB6S0E343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)