Healthcare Provider Details

I. General information

NPI: 1134768245
Provider Name (Legal Business Name): KAJSIAB SENIOR CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 W VILLARD AVE
MILWAUKEE WI
53225-3503
US

IV. Provider business mailing address

8421 W VILLARD AVE
MILWAUKEE WI
53225-3503
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-0210
  • Fax: 414-393-9916
Mailing address:
  • Phone: 414-810-0210
  • Fax: 414-393-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THONGNHI VANG XIONG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 414-810-0210