Healthcare Provider Details

I. General information

NPI: 1902993660
Provider Name (Legal Business Name): KOFI D SEFA BOAKYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL SUITE 210
CORONADO CA
92118-1978
US

IV. Provider business mailing address

344 EAST H STREET STE 1402
CHULA VISTA CA
91910
US

V. Phone/Fax

Practice location:
  • Phone: 619-435-0041
  • Fax: 619-435-1206
Mailing address:
  • Phone: 619-422-2121
  • Fax: 619-422-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG59670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: