Provider Demographics
NPI:1902442114
Name:KPANQUOI, JALLAH (BA)
Entity Type:Individual
Prefix:MR
First Name:JALLAH
Middle Name:
Last Name:KPANQUOI
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S REID ST # 338
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7030
Mailing Address - Country:US
Mailing Address - Phone:605-846-3710
Mailing Address - Fax:
Practice Address - Street 1:3905 S GRAND SLAM PL APT 7
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-4821
Practice Address - Country:US
Practice Address - Phone:763-283-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care