1245568252 NPI number — SHOBANA KUBENDRAN MBBS, MS, CGC

Table of content: SHOBANA KUBENDRAN MBBS, MS, CGC (NPI 1245568252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245568252 NPI number — SHOBANA KUBENDRAN MBBS, MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUBENDRAN
Provider First Name:
SHOBANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS, MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245568252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 47490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67201-7490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-962-3150
Provider Business Mailing Address Fax Number:
316-962-7334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3243 E MURDOCK ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67208-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-962-3070
Provider Business Practice Location Address Fax Number:
316-962-3081
Provider Enumeration Date:
12/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , with the licence number:  NA , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com