Provider Demographics
NPI:1205067782
Name:KIRIKA, LENU LETE
Entity type:Individual
Prefix:
First Name:LENU
Middle Name:LETE
Last Name:KIRIKA
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 1:819 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-2997
Mailing Address - Country:US
Mailing Address - Phone:816-841-9666
Mailing Address - Fax:816-399-4963
Practice Address - Street 1:819 E 93RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2997
Practice Address - Country:US
Practice Address - Phone:816-841-9666
Practice Address - Fax:816-399-4963
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO364632678343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO3456Medicaid
MO4567Medicaid
MO2345Medicaid