Provider Demographics
NPI:1942874136
Name:AIBANGBEE, KEZIAH EZEEMWENGHIAN (MD)
Entity type:Individual
Prefix:MS
First Name:KEZIAH
Middle Name:EZEEMWENGHIAN
Last Name:AIBANGBEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MAIN ST STE 7230
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1121
Mailing Address - Country:US
Mailing Address - Phone:716-961-6955
Mailing Address - Fax:716-862-6304
Practice Address - Street 1:955 MAIN ST STE 7230
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1121
Practice Address - Country:US
Practice Address - Phone:716-961-6955
Practice Address - Fax:716-961-6960
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2024-09-06
Deactivation Date:2022-10-27
Deactivation Code:
Reactivation Date:2022-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program