Healthcare Provider Details

I. General information

NPI: 1326465634
Provider Name (Legal Business Name): JEFFERY DEAN KUYKENDALL L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 9TH ST NW STE 1
WASHINGTON DC
20001-3361
US

IV. Provider business mailing address

1410 9TH ST NW STE 1
WASHINGTON DC
20001-3361
US

V. Phone/Fax

Practice location:
  • Phone: 202-408-4858
  • Fax: 202-408-4857
Mailing address:
  • Phone: 202-408-4858
  • Fax: 202-408-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT0982
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT0982
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: