Provider Demographics
NPI:1952875726
Name:WRIGHT, KEONI KAI
Entity type:Individual
Prefix:
First Name:KEONI
Middle Name:KAI
Last Name:WRIGHT
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 1:1346 HANCOCK ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-6130
Mailing Address - Country:US
Mailing Address - Phone:808-631-6900
Mailing Address - Fax:
Practice Address - Street 1:1346 HANCOCK ST APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-6130
Practice Address - Country:US
Practice Address - Phone:808-631-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker