Provider Demographics
NPI:1861975765
Name:OKUCU, KENYI
Entity type:Individual
Prefix:
First Name:KENYI
Middle Name:
Last Name:OKUCU
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 1:1490 148TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3459
Mailing Address - Country:US
Mailing Address - Phone:612-401-8145
Mailing Address - Fax:
Practice Address - Street 1:1490 148TH AVE NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3459
Practice Address - Country:US
Practice Address - Phone:612-401-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172A00000X
MN343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No172A00000XOther Service ProvidersDriverGroup - Single Specialty