Provider Demographics
NPI:1629233127
Name:ETOKHANA, KENNETH OSHIOKHAYAMHE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:OSHIOKHAYAMHE
Last Name:ETOKHANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23723 SUNSET PEAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7544
Mailing Address - Country:US
Mailing Address - Phone:914-356-5317
Mailing Address - Fax:
Practice Address - Street 1:401 W SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2815
Practice Address - Country:US
Practice Address - Phone:914-356-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics