KINGSON I MOMAH (Credential# 550552) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is October 1, 2015. The license expiration date date is September 30, 2016. The license status is INACTIVE.
KINGSON I MOMAH is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.032953. The credential type is physician/surgeon. The effective date is October 1, 2015. The expiration date is September 30, 2016. The business address is 5908 Broadview Avenue Ne, Tacoma, WA 98422. The current status is inactive.
| Licensee Name | KINGSON I MOMAH |
| Credential ID | 550552 |
| Credential Number | 1.032953 |
| Credential Type | Physician/Surgeon |
| Business Address |
5908 Broadview Avenue Ne Tacoma WA 98422 |
| Business Type | INDIVIDUAL |
| Status | INACTIVE - LAPSED DUE TO NON-RENEWAL |
| Issue Date | 1993-05-14 |
| Effective Date | 2015-10-01 |
| Expiration Date | 2016-09-30 |
| Refresh Date | 2017-01-03 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 163054 | CSP.0021051 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1996-03-01 - 1997-02-28 | INACTIVE |
| Street Address | 5908 Broadview Avenue NE |
| City | Tacoma |
| State | WA |
| Zip Code | 98422 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Tanisha M Mojica Mrs. | 3822 Broadmoor Dr Ne, Tacoma, WA 98422 | Registered Nurse | 2016-01-01 ~ 2016-12-31 |
| Robyn S Fujimoto | 5226 Ridge Drive Ne, Tacoma, WA 98422 | Hairdresser/cosmetician | 2002-09-20 ~ 2003-01-31 |
| Donna E Hutchinson | 4616 Country Club Dr, Tacoma, WA 98422 | Registered Nurse | ~ 2000-01-31 |
| Erik A Fulwiler | 4940 32nd St Ne, Tacoma, WA 98422-2911 | Asbestos Abatement Supervisor | 2010-07-27 ~ 2011-05-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Merchant Du Vin Corporation · Merchant Du Vin | 917 Pacific Ave Ste 501, Tacoma, WA 98402-4497 | Out of State Shipper Liquor | 2020-04-24 ~ 2021-04-23 |
| Trina Marshall | 7106 S Madison St, Tacoma, WA 98409-2464 | Hairdresser/cosmetician | 2020-05-07 ~ 2021-07-31 |
| Abigail Marie Goodale | 1748 S Cushman Ave, Tacoma, WA 98405-3534 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Naveen Gnanabakthan | 1498 Pacific Ave Ste 400, Tacoma, WA 98402-4208 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| David E Figueroa | 3202 S Mason Ave Apt N301, Tacoma, WA 98409 | Registered Nurse | 2020-06-01 ~ 2021-05-31 |
| Ssga Funds | 909 A Street, Tacoma, WA 98402 | Investment Company - Open End | 2019-12-31 ~ 2020-12-31 |
| Brecka Leigh Mayo | 1631 S 96th St, Tacoma, WA 98444 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Matthew S Ross | 5601 N. 37th St Apt Kk-04, Tacoma, WA 98407 | Professional Engineer | 2020-02-01 ~ 2021-01-31 |
| Diane M Wolford | Po Box 64007, Tacoma, WA 98464-0007 | Pharmacist | 2020-02-01 ~ 2022-01-31 |
| Joyella Diane Jones | 7615 S G St, Tacoma, WA 98408-5308 | Registered Nurse | 2020-01-07 ~ 2020-11-30 |
| Find all Licenses in Tacoma | |||
| City | Tacoma |
| Zip Code | 98422 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Tacoma |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| David N Momah | 100 Sprain Valley Rd., Scarsdale, NY 10583 | Physical Therapist | ~ |
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Susan J Batlan Md | Eye Physician Associates of Hartford, West Hartford, CT 06107 | Physician/surgeon | 2000-07-27 ~ 2001-07-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).