MEDICARE: KAKUA HEALTH AND HUMAN SERVICES PA INCOPORATION INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699613919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAKUA HEALTH AND HUMAN SERVICES PA INCOPORATION INC.

Provider Business Mailing Address
First Line	:	119 N 58TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2414
Country	:	US
Telephone Number	:	302-590-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 N 58TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-2414
Country	:	US
Telephone Number	:	302-590-8740
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	MR. PETER BOKON MAMMY
Credential	:	RN-BSN
Telephone Number	:	302-590-8740

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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