Provider Demographics
NPI:1770004335
Name:KUMI, JOSHUA AUGUSTINE
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AUGUSTINE
Last Name:KUMI
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 1:8048 BUCKMAN CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3804
Mailing Address - Country:US
Mailing Address - Phone:571-354-9813
Mailing Address - Fax:
Practice Address - Street 1:8048 BUCKMAN CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-3804
Practice Address - Country:US
Practice Address - Phone:571-354-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA66121456172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA81-4533931OtherTAXPAYER IDENTIFCATION NUMBER