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General NPI Number Information
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NPI Number | 1922304906
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Entity Type | Individual
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Provider Name | KELSON TONKUMOH
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Gender | Male
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 3535 NW 58TH ST STE 810
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4810
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Country | US
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Telephone | 405-917-5677
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Fax |
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Provider Business Mailing Address
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Address Line | 11600 SHASTA LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-1601
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Country | US
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Telephone | 405-921-7522
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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