Provider Demographics
NPI:1760113682
Name:NDIAYE, KANAH
Entity Type:Individual
Prefix:
First Name:KANAH
Middle Name:
Last Name:NDIAYE
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 1:2600 N CENTRAL AVE # B-1
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1640
Mailing Address - Country:US
Mailing Address - Phone:888-417-5163
Mailing Address - Fax:
Practice Address - Street 1:2600 N CENTRAL AVE # B-1
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1640
Practice Address - Country:US
Practice Address - Phone:888-417-5163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker