Provider Demographics
NPI:1720160997
Name:KABAFUSION KY, LLC
Entity Type:Organization
Organization Name:KABAFUSION KY, LLC
Other - Org Name:KABAFUSION KY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SOHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-435-3020
Mailing Address - Street 1:17777 CENTER COURT DR N STE 550
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9337
Mailing Address - Country:US
Mailing Address - Phone:800-435-3020
Mailing Address - Fax:
Practice Address - Street 1:5694 SHEPHERDSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1014
Practice Address - Country:US
Practice Address - Phone:502-266-5001
Practice Address - Fax:502-266-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0294030265Medicare NSC