MEDICARE: MR. KWABENA SARKODIE-MENSAH LVN

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	164X00000X	Licensed Vocational Nurse	VN264129	CA

General Provider Information

NPI Number	:	1811256829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KWABENA SARKODIE-MENSAH LVN

Provider Business Mailing Address
First Line	:	3520 LONG BEACH BLVD
Second Line	:	STE. 205
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3906
Country	:	US
Telephone Number	:	562-426-5035
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 LONG BEACH BLVD
Second Line	:	STE. 205
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3906
Country	:	US
Telephone Number	:	562-426-5035
Fax Number	:

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

Provider Enumeration Date	:	05/10/2012
Last Update Date	:	08/06/2013

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