Provider Demographics
NPI:1932456498
Name:ALI, KAFYA HALLY
Entity Type:Individual
Prefix:
First Name:KAFYA HALLY
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80048
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-8048
Mailing Address - Country:US
Mailing Address - Phone:612-200-8839
Mailing Address - Fax:612-545-5463
Practice Address - Street 1:1 W LAKE ST STE 196
Practice Address - Street 2:SUITE 196
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3154
Practice Address - Country:US
Practice Address - Phone:612-200-8839
Practice Address - Fax:612-545-5463
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies