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General NPI Number Information
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NPI Number | 1821821059
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Entity Type | Organization
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Legal Business Name | DR KESSIENA AYA LLC
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 95 S 10TH ST APT 1107TH
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City | MINNEAPOLIS
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State | MN
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Zip | 55403-2431
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Country | US
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Telephone | 320-480-0001
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Fax | 320-525-1234
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Provider Business Mailing Address
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Address Line | 1873 10TH AVE E APT 218
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City | ALEXANDRIA
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State | MN
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Zip | 56308-2646
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Country | US
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Telephone | 320-480-0001
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Fax | 320-525-1234
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Authorized Official
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Title or Position | PRESIDENT
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Name | KESSIENA AYA
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Credential | DO
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Telephone | 813-850-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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