Provider Demographics
NPI:1629840343
Name:DAMI, KODJO
Entity Type:Individual
Prefix:
First Name:KODJO
Middle Name:
Last Name:DAMI
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 1:145 BEAVER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1701
Mailing Address - Country:US
Mailing Address - Phone:617-230-7596
Mailing Address - Fax:
Practice Address - Street 1:145 BEAVER ST APT 1
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1701
Practice Address - Country:US
Practice Address - Phone:617-230-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230209163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse