MEDICARE: KINI CORPORATION

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1750759379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINI CORPORATION

Provider Business Mailing Address
First Line	:	2750 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4285
Country	:	US
Telephone Number	:	704-806-4228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 E WT HARRIS BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4285
Country	:	US
Telephone Number	:	704-806-4228
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED HAIR LOSS SPECIALIST
Name	:	MS. KIMBERLY WILLIAMS
Credential	:
Telephone Number	:	704-806-4228

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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Directions to “KINI CORPORATION ” Practice Location

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