Provider Demographics
NPI:1922304906
Name:TONKUMOH, KELSON
Entity Type:Individual
Prefix:
First Name:KELSON
Middle Name:
Last Name:TONKUMOH
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 1:11600 SHASTA LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-1601
Mailing Address - Country:US
Mailing Address - Phone:405-921-7522
Mailing Address - Fax:
Practice Address - Street 1:3535 NW 58TH ST STE 810
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4810
Practice Address - Country:US
Practice Address - Phone:405-917-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist