Healthcare Provider Details

I. General information

NPI: 1275786931
Provider Name (Legal Business Name): MANJU B KAKU MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVENUE, NW CHIDREN'S NATIONAL MEDICAL CENTER
WASHINGTON, DC DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4013
  • Fax: 202-476-2163
Mailing address:
  • Phone: 202-476-4013
  • Fax: 202-476-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number00593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: