Provider Demographics
NPI:1699536722
Name:KK&J MEDICAL DIAGNOSTICS LLC
Entity type:Organization
Organization Name:KK&J MEDICAL DIAGNOSTICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:803-849-9803
Mailing Address - Street 1:6625 ARGYLE FOREST BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6126
Mailing Address - Country:US
Mailing Address - Phone:904-862-1944
Mailing Address - Fax:
Practice Address - Street 1:6625 ARGYLE FOREST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6126
Practice Address - Country:US
Practice Address - Phone:803-613-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center