Provider Demographics
NPI:1902157068
Name:HKKM
Entity Type:Organization
Organization Name:HKKM
Other - Org Name:JJHJKM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYHNGN
Authorized Official - Middle Name:HJH
Authorized Official - Last Name:VHB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-789-6541
Mailing Address - Street 1:25151 EUCLID
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:216-857-4135
Mailing Address - Fax:
Practice Address - Street 1:25151 EUCLID
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120
Practice Address - Country:US
Practice Address - Phone:216-857-4135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302R00000X
OH305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization