Provider Demographics
NPI:1972701142
Name:KIONI, FRED WAITHAKA
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:WAITHAKA
Last Name:KIONI
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 1:13154 COIT RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5773
Mailing Address - Country:US
Mailing Address - Phone:972-709-7702
Mailing Address - Fax:972-709-7708
Practice Address - Street 1:4121 MARVIN D LOVE FWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4800
Practice Address - Country:US
Practice Address - Phone:972-709-7702
Practice Address - Fax:972-709-7708
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011187251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health