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Individual

KODI HUMPAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
9040 JACKSON AVE, TACOMA, WA 98431-5102
(909) 809-0395
Mailing address
1585 3RD ST, FORT POLK, LA 71459-5102

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD-21376
HI

Other

Enumeration date
06/06/2019
Last updated
06/30/2025
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