Provider Demographics
NPI:1710719885
Name:KUM, THEOPHILUS K
Entity type:Individual
Prefix:
First Name:THEOPHILUS
Middle Name:K
Last Name:KUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:COMMUNITY
Other - Middle Name:COMPREHENSIVE
Other - Last Name:CARE LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5150 ASTER PARK DR APT 2009
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8796
Mailing Address - Country:US
Mailing Address - Phone:513-663-2194
Mailing Address - Fax:
Practice Address - Street 1:5150 ASTER PARK DR APT 2009
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45011-8796
Practice Address - Country:US
Practice Address - Phone:513-663-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH9924483314251E00000X
OH992448314251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health