Healthcare Provider Details

I. General information

NPI: 1720466261
Provider Name (Legal Business Name): KATIE KOKENGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14660 OXNARD ST
VAN NUYS CA
91411-3119
US

IV. Provider business mailing address

14660 OXNARD ST
VAN NUYS CA
91411-3119
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4836
  • Fax:
Mailing address:
  • Phone: 818-901-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number85598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: