Healthcare Provider Details

I. General information

NPI: 1871176727
Provider Name (Legal Business Name): KORAIMA CEDENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 W 151ST ST
OLATHE KS
66061-5350
US

IV. Provider business mailing address

267 GRANT ST
BRIDGEPORT CT
06610-2805
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 203-384-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number04-53874
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number04-53874
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: