Individual provider · NPI-1

Kwame Boateng Agyeman

Internal Medicine · Loma Linda, CA

NPI number1821521527
StatusActive
Last updated in NPPESJul 6, 2021

Details

NPI
1821521527
Entity type
Individual (NPI-1)
Name
Mr. Kwame Boateng Agyeman
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 10, 2017
Certification date
Jul 6, 2021
Last updated
Jul 6, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineA158219CAYes

Practice location

25590 Prospect Ave
43e
Loma Linda, CA 92354-3141

Phone 951-640-9517

Mailing address

25590 Prospect Ave
43e
Loma Linda, CA 92354-3141

Phone 951-640-9517

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