Healthcare Provider Details

I. General information

NPI: 1821887704
Provider Name (Legal Business Name): UMANGA KC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 08/13/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 KIMBALL AVENUE, MERCYONE NORTH IOWA WATERLOO FAMIL STE 101
WATERLOO IA
50702
US

IV. Provider business mailing address

2055 KIMBALL AVENUE, MERCYONE NORTH IOWA WATERLOO FAMIL STE 101
WATERLOO IA
50702
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-2112
  • Fax:
Mailing address:
  • Phone: 319-272-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-13399
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: