Healthcare Provider Details

I. General information

NPI: 1942477385
Provider Name (Legal Business Name): KANOKY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 E NORTHERN AVE
PHOENIX AZ
85020-4218
US

IV. Provider business mailing address

1321 E NORTHERN AVE
PHOENIX AZ
85020-4218
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-2940
  • Fax: 602-997-2494
Mailing address:
  • Phone: 602-943-2940
  • Fax: 602-997-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name: JOHN ROSE
Title or Position: PRESIDENT
Credential:
Phone: 602-943-2940