Healthcare Provider Details

I. General information

NPI: 1679295646
Provider Name (Legal Business Name): KOFI ADJEPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 VIKING DR
SACRAMENTO CA
95827-2844
US

IV. Provider business mailing address

3440 VIKING DR
SACRAMENTO CA
95827-2844
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-8598
  • Fax: 916-287-4068
Mailing address:
  • Phone: 916-262-8598
  • Fax: 916-287-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: