MEDICARE: KOFI D SEFA BOAKYE MD

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	207V00000X	Obstetrics & Gynecology Physician	G59670	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FHC11992H	OTHER		MEDI CAL

General Provider Information

NPI Number	:	1902993660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOFI D SEFA BOAKYE MD

Provider Business Mailing Address
First Line	:	344 EAST H STREET
Second Line	:	STE 1402
City	:	CHULA VISTA
State	:	CA
Zip	:	91910
Country	:	US
Telephone Number	:	619-422-2121
Fax Number	:	619-422-2427

Provider Business Practice Location Address
First Line	:	230 PROSPECT PL
Second Line	:	SUITE 210
City	:	CORONADO
State	:	CA
Zip	:	92118-1978
Country	:	US
Telephone Number	:	619-435-0041
Fax Number	:	619-435-1206

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/25/2013

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Directions to “ KOFI D SEFA BOAKYE MD” Practice Location

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