Provider Demographics
NPI:1902993660
Name:SEFA BOAKYE, KOFI D (MD)
Entity Type:Individual
Prefix:
First Name:KOFI
Middle Name:D
Last Name:SEFA BOAKYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:344 EAST H STREET
Mailing Address - Street 2:STE 1402
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-422-2121
Mailing Address - Fax:619-422-2427
Practice Address - Street 1:230 PROSPECT PL
Practice Address - Street 2:SUITE 210
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1978
Practice Address - Country:US
Practice Address - Phone:619-435-0041
Practice Address - Fax:619-435-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG59670207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC11992HOtherMEDI CAL
FHC11992HOtherMEDI CAL