Kokopelli East West Integrated Family Healthcare, LLC

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2033 Issued in NM

Legal business name

KOKOPELLI EAST WEST INTEGRATED FAMILY HEALTHCARE, LLC

Practice address

2808 Mesa Rd SE
Rio Rancho, NM 87124-7229

Phone

(505) 994-0669

NPI assigned

Apr 25, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. James Dalkyu Park, PT, DOMNPI 1255396719

Title

Managing Officer

Phone

(505) 514-2900

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James D Park, DOM

  • Physical Therapist
  • Albuquerque, NM
  • NPI 1255396719
  Authorized official Same address or phone

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396964318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 FOREST HILLS DR NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094129",
            "telephone_number": "505-514-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2808 MESA RD SE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871247229",
            "telephone_number": "505-994-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKOPELLI EAST WEST INTEGRATED FAMILY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "DALKYU",
        "authorized_official_title_or_position": "MANAGING OFFICER",
        "authorized_official_telephone_number": "505-514-2900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DOM"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NM",
            "license": "2033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1929182795",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dallon Knight, PHARM.D.
• Versai Knight
• Yvonne Maud Knowles, OTR/L
• Lisa Ko
• Anna Lise Koenig, M.D.
• Clavel Kole, M.A., CCC-SLP
• Lindsey Kolikant
• Komala Therapeutic Massage
• Sarah E Komala, LMT
• Kristen Konstantakis

• Occupational Therapy Assistant in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Occupational Therapy Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.