Healthcare Provider Details

I. General information

NPI: 1689121899
Provider Name (Legal Business Name): LINDA KUTI-KINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 OLD LANTERN RD
DANBURY CT
06810-8444
US

IV. Provider business mailing address

36 OLD LANTERN RD
DANBURY CT
06810-8444
US

V. Phone/Fax

Practice location:
  • Phone: 203-778-4852
  • Fax:
Mailing address:
  • Phone: 203-778-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number577341941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: