Provider Demographics
NPI:1871922880
Name:AKJ MEDICAL WELLNESS LLC
Entity type:Organization
Organization Name:AKJ MEDICAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINGCADE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:215-237-9216
Mailing Address - Street 1:534 W MIDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4618
Mailing Address - Country:US
Mailing Address - Phone:215-237-9216
Mailing Address - Fax:
Practice Address - Street 1:501 CAMBRIA AVE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-7213
Practice Address - Country:US
Practice Address - Phone:215-237-9216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003041L261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service