Provider Demographics
NPI:1437969201
Name:KSN PRIMARY CARE LLC
Entity type:Organization
Organization Name:KSN PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SULONGTEH-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-310-6812
Mailing Address - Street 1:1841 FAIRLAWN KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5435
Mailing Address - Country:US
Mailing Address - Phone:330-310-6812
Mailing Address - Fax:
Practice Address - Street 1:1841 FAIRLAWN KNOLLS DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5435
Practice Address - Country:US
Practice Address - Phone:330-310-6812
Practice Address - Fax:330-776-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty