MEDICARE: KEMON JAKIM HARVEY

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	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1770432841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEMON JAKIM HARVEY

Provider Business Mailing Address
First Line	:	512 GATEWAY CENTRE PKWY APT 409
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5138
Country	:	US
Telephone Number	:	804-943-5418
Fax Number	:	804-943-5418

Provider Business Practice Location Address
First Line	:	512 GATEWAY CENTRE PKWY APT 409
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5138
Country	:	US
Telephone Number	:	804-943-5418
Fax Number	:	804-943-5418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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