Provider Demographics
NPI:1689121899
Name:KUTI-KINGHAM, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KUTI-KINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OLD LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-8444
Mailing Address - Country:US
Mailing Address - Phone:203-778-4852
Mailing Address - Fax:
Practice Address - Street 1:36 OLD LANTERN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-8444
Practice Address - Country:US
Practice Address - Phone:203-778-4852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577341941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist