Healthcare Provider Details

I. General information

NPI: 1225529191
Provider Name (Legal Business Name): JEAN-LUC KALONDA KABANGU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E MEYER BLVD STE 411
KANSAS CITY MO
64132-1152
US

IV. Provider business mailing address

2330 E MEYER BLVD STE 411
KANSAS CITY MO
64132-1152
US

V. Phone/Fax

Practice location:
  • Phone: 816-363-2500
  • Fax: 816-363-8741
Mailing address:
  • Phone: 816-363-2500
  • Fax: 816-363-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number73677
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number34938
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2026030716
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number04-53181
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: