Provider Demographics
NPI:1356118681
Name:YAI BULAWAH, KENNETH YAI
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:YAI
Last Name:YAI BULAWAH
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 1:4920 NAPLES AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1835
Mailing Address - Country:US
Mailing Address - Phone:443-864-1153
Mailing Address - Fax:
Practice Address - Street 1:4920 NAPLES AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1835
Practice Address - Country:US
Practice Address - Phone:443-864-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator