Provider Demographics
NPI:1982092359
Name:ASIEDU, KENNETH OWUSU (PA)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:OWUSU
Last Name:ASIEDU
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:404 E 158TH ST
Mailing Address - Street 2:APT 6G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4556
Mailing Address - Country:US
Mailing Address - Phone:347-837-4499
Mailing Address - Fax:
Practice Address - Street 1:174 GRAND ST
Practice Address - Street 2:DOCTORS UNITED INC
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-328-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical