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General NPI Number Information
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NPI Number | 1679271670
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Entity Type | Individual
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Provider Name | DR. AUGUSTINE KWAKU AGYEKUM
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Gender | Male
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 1815 BLACKBERRY LN
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City | GLADWYNE
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State | PA
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Zip | 19035-1101
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Country | US
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Telephone | 877-225-0316
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Fax |
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Provider Business Mailing Address
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Address Line | 932 7TH ST APT 4
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City | SANTA MONICA
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State | CA
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Zip | 90403-2735
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Country | US
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Telephone | 215-779-0805
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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 | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | PA
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