NDIKA FOMUKONG


Address: 210 Canal St, King City, CA 93930-3432
Phone: 8313855471

NDIKA FOMUKONG (NPI# 1497700066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497700066
Entity Type Individual
Full Name NDIKA FOMUKONG
Credential P.A.C
Practice Address 210 Canal St
King City
CA 93930-3432
Practice Telephone 8313855471
Practice Fax Number 8313855940
Mailing Telephone 8313855471
Mailing Fax Number 8313855940
Enumeration Date 2006-05-23
Last Update Date 2013-11-20
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant PA17839 CA Physician Assistants & Advanced Practice Nursing Providers
Y 363LP2300X Nurse Practitioner
Specialization: Primary Care
NP 17180 CA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 210 CANAL ST
City KING CITY
State CA
Zip Code 93930-3432

Providers in the same location

NPI Name Taxonomy Address Enumeration
1255316931 Sandra Montijo Pediatrics 210 Canal St, King City, CA 93930-3432 2005-12-14
1164607180 Southern Monterey County Memorial Hospital Clinic/Center 210 Canal St, King City, CA 93930-3432 2008-01-09
1720279094 Southern Monterey County Memorial Hospital Clinic/Center 210 Canal St, King City, CA 93930-3432 2007-08-05
1811188188 Southern Monterey County Memorial Hospital Clinic/Center 210 Canal St, King City, CA 93930-3432 2007-08-05
1518185305 Dan Q. Tran Internal Medicine 210 Canal St, King City, CA 93930-3432 2007-04-24
1760516314 Gilbert E. Flores Surgery 210 Canal St, King City, CA 93930-3432 2007-03-15
1467521922 Barbara Corinne Pekema Nurse Practitioner 210 Canal St, King City, CA 93930-3432 2006-11-07
1285685743 Southern Monterey County Memorial Hospital Clinic/Center 210 Canal St, King City, CA 93930-3432 2006-05-12
1659344927 Richard H. Fair Obstetrics & Gynecology 210 Canal St, King City, CA 93930-3432 2006-02-08
1477539831 Jonathan Pace Surgery 210 Canal St, King City, CA 93930-3432 2005-12-19
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1841841202 Carl Jorgensen Pharmacist Riteaid, 540 Canal Street, King City, CA 93930 2019-09-26
1750780284 Kayla Noon Counselor 200 Broadway St., Suite 70, King City, CA 93930 2014-08-20
1831323906 Tawfiq Imam Pharmacist 540 Canal St, Rite Aid Pharmacy #5880, King City, CA 93930 2009-05-05
1588165351 Mirella Mendoza Nurse Practitioner 122 E San Antonio Dr, King City, CA 93930 2018-02-26
1437510641 Christina Sandoval Counselor 200 Broadway St, 70, King City, CA 93930 2016-03-15
1376920850 Celia Trujillo Counselor 200 Broadway St, King City, CA 93930 2015-05-04
1497152078 Nguyen Pham Internal Medicine 300 Canal St, King City, CA 93930 2014-11-26
1104171925 Hassan Jadid Internal Medicine 300 Canal St, King City, CA 93930 2012-07-18
1821227422 Jovanna M Velazquez Technician, Other 200 Broadway, Suite 88, King City, CA 93930 2009-07-06
1598961161 Diane Lynn Hardy Marriage & Family Therapist 522 Broadway St, Suite D, King City, CA 93930 2007-06-21
Find all providers in zip 93930

Taxonomy Information

Taxonomy Code 363LP2300X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Primary Care

Taxonomy Definition

Definition to come...

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1487266292 Mollie Shira Hudson Nurse Practitioner 14 Whitmore Pl Apt 15, Oakland, CA 94611-4635 2020-08-21
1962014381 Mario Javier Herrera Nurse Practitioner 2130 High Pointe Dr, Apt 108, Corona, CA 92879 2020-08-18
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Competitor

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City KING CITY
Zip Code 93930

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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