Healthcare Provider Details

I. General information

NPI: 1194687541
Provider Name (Legal Business Name): STYVE SOH FEUDJO KAMLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RAREY AVE E
GROVEPORT OH
43125-9639
US

IV. Provider business mailing address

5740 RAREY AVE E
GROVEPORT OH
43125-9639
US

V. Phone/Fax

Practice location:
  • Phone: 380-213-2930
  • Fax:
Mailing address:
  • Phone: 380-213-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: