Provider Demographics
NPI:1730470576
Name:KONDO-OVIATT, KAORI
Entity Type:Individual
Prefix:MS
First Name:KAORI
Middle Name:
Last Name:KONDO-OVIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAORI
Other - Middle Name:
Other - Last Name:KONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7344 AUSTIN ST APT 5R
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6222
Mailing Address - Country:US
Mailing Address - Phone:212-683-8905
Mailing Address - Fax:212-683-8906
Practice Address - Street 1:161 MADISON AVE RM 2W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5463
Practice Address - Country:US
Practice Address - Phone:212-683-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069819-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator