Provider Demographics
NPI:1760754535
Name:INYANG, AKANIFIOK CLEMENT
Entity Type:Individual
Prefix:MR
First Name:AKANIFIOK
Middle Name:CLEMENT
Last Name:INYANG
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 1:2130 HUNTINGTON DR
Mailing Address - Street 2:STE. 313
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4964
Mailing Address - Country:US
Mailing Address - Phone:626-799-0868
Mailing Address - Fax:626-799-8848
Practice Address - Street 1:2130 HUNTINGTON DR
Practice Address - Street 2:STE. 313
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4964
Practice Address - Country:US
Practice Address - Phone:626-799-0868
Practice Address - Fax:626-799-8848
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA954770156332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies