Healthcare Provider Details

I. General information

NPI: 1609250273
Provider Name (Legal Business Name): KENNETH IWUAFOR PA-C, CAQ-PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E DUBLIN GRANVILLE RD STE 300KK
COLUMBUS OH
43231-4094
US

IV. Provider business mailing address

2700 E DUBLIN GRANVILLE RD STE 300KK
COLUMBUS OH
43231-4094
US

V. Phone/Fax

Practice location:
  • Phone: 614-284-3446
  • Fax: 614-633-1534
Mailing address:
  • Phone: 614-284-3446
  • Fax: 614-633-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number50.004316RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number50.004316RX
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004316RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: