Provider Demographics
NPI:1619486552
Name:SOK, KENMAKARA
Entity Type:Individual
Prefix:
First Name:KENMAKARA
Middle Name:
Last Name:SOK
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 1:2731 SKYVIEW POINT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-8123
Mailing Address - Country:US
Mailing Address - Phone:832-274-3059
Mailing Address - Fax:
Practice Address - Street 1:4025 W FUQUA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-6303
Practice Address - Country:US
Practice Address - Phone:800-298-3948
Practice Address - Fax:888-331-4002
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19442152OtherTX DRIVER'S LIC