Provider Demographics
NPI:1174654354
Name:KYUBWA, AMEDE B (MA , MPA)
Entity Type:Individual
Prefix:
First Name:AMEDE
Middle Name:B
Last Name:KYUBWA
Suffix:
Gender:M
Credentials:MA , MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 FRANKLIN BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1820
Mailing Address - Country:US
Mailing Address - Phone:916-394-9195
Mailing Address - Fax:
Practice Address - Street 1:3870 ROSIN CT STE 130
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1647
Practice Address - Country:US
Practice Address - Phone:916-363-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor