Healthcare Provider Details

I. General information

NPI: 1548850860
Provider Name (Legal Business Name): YAW DAAKU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 ROSCOE BLVD
NORTHRIDGE CA
91325-4167
US

IV. Provider business mailing address

18300 ROSCOE BLVD
NORTHRIDGE CA
91325-4167
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-8500
  • Fax: 818-885-3584
Mailing address:
  • Phone: 818-885-8500
  • Fax: 818-885-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number487530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: