Individual
DR. KUUMBA K LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 W LINCOLN RD, KOKOMO, IN 46902
(765) 453-5696
(765) 455-4323
Mailing address
PO BOX 549, WABASH, IN 46992-0549
(260) 569-9550
(260) 569-9244
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01066913A
IN
207W00000X
Ophthalmology Physician
A97642
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000623704
ANTHEM PROVIDER NUMBER
IN
01
—
09161
PI NUMBER
CA
05
—
200950820
—
IN
Enumeration date
02/06/2007
Last updated
08/15/2018
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