Provider Demographics
NPI:1720872153
Name:BOKUM, KADIJATU
Entity type:Individual
Prefix:
First Name:KADIJATU
Middle Name:
Last Name:BOKUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 156TH ST APT 15C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1434
Mailing Address - Country:US
Mailing Address - Phone:347-942-7062
Mailing Address - Fax:
Practice Address - Street 1:510 E 156TH ST APT 15C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1434
Practice Address - Country:US
Practice Address - Phone:347-942-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator