Provider Demographics
NPI:1528096435
Name:KAKUMBA, KEMUNTO PHOEBE (MD)
Entity type:Individual
Prefix:
First Name:KEMUNTO
Middle Name:PHOEBE
Last Name:KAKUMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KEMUNTO
Other - Middle Name:PHOEBE
Other - Last Name:OMWEGA-KAKUMBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:611 N IRON BRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-444-8888
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5095
Practice Address - Country:US
Practice Address - Phone:509-444-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8381832Medicaid
WAI01204Medicare UPIN
WA8381832Medicaid