Provider Demographics
NPI:1740930858
Name:KAMAKA, JEFFREY J
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:KAMAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:J
Other - Last Name:KAMAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2110
Mailing Address - Country:US
Mailing Address - Phone:610-348-4426
Mailing Address - Fax:
Practice Address - Street 1:131 ROLLING RIDGE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7675
Practice Address - Country:US
Practice Address - Phone:814-237-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAA03622237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1740930858OtherNPI