MEDICARE: KENMAKARA SOK

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	247200000X	Other Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19442152	OTHER	TX	TX DRIVER'S LIC

General Provider Information

NPI Number	:	1619486552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENMAKARA SOK

Provider Business Mailing Address
First Line	:	2731 SKYVIEW POINT DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-8123
Country	:	US
Telephone Number	:	832-274-3059
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 W FUQUA ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-6303
Country	:	US
Telephone Number	:	800-298-3948
Fax Number	:	888-331-4002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	09/22/2017

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Directions to “ KENMAKARA SOK ” Practice Location

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