Provider Demographics
NPI:1699445668
Name:BABAK, KENNETH H
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:BABAK
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 1:4502 KING ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9646
Mailing Address - Country:US
Mailing Address - Phone:330-604-6675
Mailing Address - Fax:
Practice Address - Street 1:4502 KING ARTHUR DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9646
Practice Address - Country:US
Practice Address - Phone:330-604-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
OHRJ695863343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)