Provider Demographics
NPI:1982396685
Name:AMODA, KEHINDE RICHARD
Entity Type:Individual
Prefix:PROF
First Name:KEHINDE
Middle Name:RICHARD
Last Name:AMODA
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 1:4606 FM 1960 RD W STE 560
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-4617
Mailing Address - Country:US
Mailing Address - Phone:832-995-8532
Mailing Address - Fax:
Practice Address - Street 1:4606 FM 1960 RD W STE 560
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-4617
Practice Address - Country:US
Practice Address - Phone:832-995-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45389328343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)