Provider Demographics
NPI:1851528228
Name:MALONEY, KUDAKWASHE KUDA (MD)
Entity type:Individual
Prefix:
First Name:KUDAKWASHE
Middle Name:KUDA
Last Name:MALONEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OAKWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3128
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:
Practice Address - Street 1:5373 W ALABAMA ST STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5923
Practice Address - Country:US
Practice Address - Phone:281-607-7739
Practice Address - Fax:281-299-0091
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036170736207N00000X
TXP9644207ZD0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351829203Medicaid
TX432197YKQHMedicare PIN