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General NPI Number Information
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NPI Number | 1235024647
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Entity Type | Individual
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Provider Name | NKESE JAPHIA JACK DPT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3300 E SOUTH ST STE 203
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City | LAKEWOOD
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State | CA
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Zip | 90805-4589
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Country | US
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Telephone | 526-512-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 18225 KINGSDALE AVE APT 216
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City | REDONDO BEACH
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State | CA
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Zip | 90278-4663
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Country | US
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Telephone | 224-292-9671
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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