Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | A168338 | CA |
Y | 111NI0900X | Internist | A168338 | CA |
N | 207RI0200X | Infectious Disease | A168338 | CA |
N | 208000000X | Pediatrician | A168338 | CA |
NPI | 1023472743 |
---|---|
Provider Name | Kevin Dipondo Ouma |
First Address | Fresno, CA 93706-3600 |
Second Address | Fresno, CA 93706-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2016 |
Last Update Date | 15/07/2020 |