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Individual
SUNDANCE ZXAINE KEMP
Active
Individual
SUNDANCE ZXAINE KEMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000098A
IN
367H00000X
Anesthesiologist Assistant
TL95
SC
367H00000X
Anesthesiologist Assistant
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M22404254
MEDICARE PTAN
IN
05
—
PENDING
—
SC
Enumeration date
12/25/2021
Last updated
08/29/2023
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