Provider Demographics
NPI:1144904152
Name:WAHU, KENNETH GITAHI
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:GITAHI
Last Name:WAHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 SW 326TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2534
Mailing Address - Country:US
Mailing Address - Phone:206-503-5439
Mailing Address - Fax:
Practice Address - Street 1:3232 SW 326TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2534
Practice Address - Country:US
Practice Address - Phone:206-503-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL29SSJ223B172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver