Provider Demographics
NPI:1366262024
Name:TIOKENG KENYANTIO, ADRIEN
Entity type:Individual
Prefix:
First Name:ADRIEN
Middle Name:
Last Name:TIOKENG KENYANTIO
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 1:3314 BATTLECRY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4672
Mailing Address - Country:US
Mailing Address - Phone:214-545-7866
Mailing Address - Fax:
Practice Address - Street 1:8122 MARBACH RD STE 121
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1690
Practice Address - Country:US
Practice Address - Phone:210-569-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant