Healthcare Provider Details

I. General information

NPI: 1548181001
Provider Name (Legal Business Name): KAAKOU ATTAWODI POKONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-2 KM 173
SAN GERMAN PR
00683
US

IV. Provider business mailing address

6408 92ND TRL N
BROOKLYN PARK MN
55445-1650
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1860
  • Fax:
Mailing address:
  • Phone: 787-892-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17924-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: