Provider Demographics
NPI:1538708201
Name:JIMBA-BIDMUS, KAFILAT TOLANI
Entity type:Individual
Prefix:
First Name:KAFILAT
Middle Name:TOLANI
Last Name:JIMBA-BIDMUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 SIMS POINTE CT
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-4564
Mailing Address - Country:US
Mailing Address - Phone:732-645-1866
Mailing Address - Fax:
Practice Address - Street 1:3811 SIMS POINTE CT
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-4564
Practice Address - Country:US
Practice Address - Phone:732-645-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0450084188251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare