Provider Demographics
NPI:1033142088
Name:ADUBOFOUR, KWABENA OPOKU-MENSAH (MD)
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:OPOKU-MENSAH
Last Name:ADUBOFOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-0188
Mailing Address - Country:US
Mailing Address - Phone:800-249-9497
Mailing Address - Fax:209-845-1364
Practice Address - Street 1:2524 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-6523
Practice Address - Country:US
Practice Address - Phone:800-249-9497
Practice Address - Fax:800-249-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52394OtherMEDICAL LICENSE
CAA52394OtherMEDICAL LICENSE