Healthcare Provider Details

I. General information

NPI: 1962623017
Provider Name (Legal Business Name): KINSKAY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 TEMPE DR
PALMDALE CA
93552-6029
US

IV. Provider business mailing address

5633 TEMPE DR
PALMDALE CA
93552-6029
US

V. Phone/Fax

Practice location:
  • Phone: 661-533-5404
  • Fax:
Mailing address:
  • Phone: 661-533-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number47261
License Number StateCA

VIII. Authorized Official

Name: OLUWAKEMI KAYODEAKINSILO
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 661-533-5405