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General NPI Number Information
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NPI Number | 1952080822
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Entity Type | Organization
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Legal Business Name | KENKO PLLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 14130 NOBLEWOOD PLZ STE 301
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1467
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Country | US
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Telephone | 703-485-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 14130 NOBLEWOOD PLZ STE 301
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1467
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Country | US
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Telephone | 703-485-0470
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTHA CASAMALHUAPA
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Credential | MD
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Telephone | 703-485-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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