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General NPI Number Information
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NPI Number | 1023760683
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Entity Type | Individual
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Provider Name | ANTHONY KAGUA
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Gender | Male
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 11206 W 72ND TER
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City | SHAWNEE
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State | KS
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Zip | 66203-4352
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Country | US
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Telephone | 617-984-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 11206 W 72ND TER
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City | SHAWNEE
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State | KS
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Zip | 66203-4352
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Country | US
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Telephone | 617-984-9477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | B046060
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License Number State | KS
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