Active NPI
Kuditshini Kakese Mukendi, IDC
- Independent Duty Corpsman
- San Diego, CA
National Provider Identifier
1083059224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Independent Duty Corpsman
- Practice address
- 8829 Spectrum Center Blvd
Apt 3111
San Diego, CA 92123-1457 - Phone
- (843) 228-2111
- NPI assigned
- May 1, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Corpsman | 1710I1002X | Primary |
Addresses
Primary practice location
8829 Spectrum Center Blvd
Apt 3111
San Diego, CA 92123-1457
Mailing address
283 Blvd de France
Parris Island, SC 29905
Phone (843) 228-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710/1002X | Other | IDC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1367366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367366400000",
"number": "1083059224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "283 BLVD DE FRANCE",
"city": "PARRIS ISLAND",
"state": "SC",
"postal_code": "29905",
"telephone_number": "843-228-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8829 SPECTRUM CENTER BLVD",
"address_2": "APT 3111",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231457",
"telephone_number": "843-228-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUKENDI",
"first_name": "KUDITSHINI",
"middle_name": "KAKESE",
"credential": "IDC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-01",
"last_updated": "2013-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1710I1002X",
"taxonomy_group": "",
"desc": "Military Health Care Provider, Independent Duty Corpsman",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDC",
"identifier": "1710/1002X",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.