Ete-Kamba Jeremiah Amaku, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

127946 Issued in CA

Practice address

540 Ralston Ave
Suite B
Belmont, CA 94002-2869

Phone

(650) 363-5668

Fax

(650) 363-5669

NPI assigned

Jan 19, 2012

Last updated

Jan 21, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327104000000",
    "number": "1215208574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 RALSTON AVE",
            "address_2": "SUITE B",
            "city": "BELMONT",
            "state": "CA",
            "postal_code": "940022869",
            "telephone_number": "650-363-5668",
            "fax_number": "650-363-5669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 RALSTON AVE",
            "address_2": "SUITE B",
            "city": "BELMONT",
            "state": "CA",
            "postal_code": "940022869",
            "telephone_number": "650-363-5668",
            "fax_number": "650-363-5669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMAKU",
        "first_name": "ETE-KAMBA",
        "middle_name": "JEREMIAH",
        "credential": "MS, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "127946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Belmont, CA
• Providers in Belmont, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.