MEDICARE: ALFRED KPEKPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568438315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALFRED KPEKPE

Provider Business Mailing Address
First Line	:	1807 W 108TH STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-4417
Country	:	US
Telephone Number	:	323-777-2797
Fax Number	:	323-777-2754

Provider Business Practice Location Address
First Line	:	1807 W 108TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-4417
Country	:	US
Telephone Number	:	323-777-2797
Fax Number	:	323-777-2754

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALFRED KPEKPE
Credential	:
Telephone Number	:	323-777-2797

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/17/2008

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Directions to “ALFRED KPEKPE ” Practice Location

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