Healthcare Provider Details

I. General information

NPI: 1417874959
Provider Name (Legal Business Name): EDMOND AKUAMOAH FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 W FLORENCE AVE
LOS ANGELES CA
90044-2441
US

IV. Provider business mailing address

300 N BEAUDRY AVE APT 6041
LOS ANGELES CA
90012-3489
US

V. Phone/Fax

Practice location:
  • Phone: 323-776-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95040049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: