MEDICARE: KINGSWAY INTERNATIONAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1316805104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSWAY INTERNATIONAL LLC

Provider Business Mailing Address
First Line	:	9738 NORTHSTAR CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-5183
Country	:	US
Telephone Number	:	209-888-4788
Fax Number	:	209-490-4126

Provider Business Practice Location Address
First Line	:	9738 NORTHSTAR CT
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-5183
Country	:	US
Telephone Number	:	209-888-4788
Fax Number	:	209-490-4126

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	PRINCEWILL NWAOGU
Credential	:
Telephone Number	:	925-202-8447

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “KINGSWAY INTERNATIONAL LLC ” Practice Location

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