Healthcare Provider Details

I. General information

NPI: 1891621629
Provider Name (Legal Business Name): AMINKENG NKAFU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 E 3RD WAY
LA CENTER WA
98629-2666
US

IV. Provider business mailing address

1507 E 3RD WAY
LA CENTER WA
98629-2666
US

V. Phone/Fax

Practice location:
  • Phone: 240-890-3306
  • Fax: 855-793-0182
Mailing address:
  • Phone: 240-890-3306
  • Fax: 855-793-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number759095
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: