Provider Demographics
NPI:1336502707
Name:KUYBU, OKKES
Entity Type:Individual
Prefix:
First Name:OKKES
Middle Name:
Last Name:KUYBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 SONOMA STREET
Mailing Address - Street 2:STE B
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2536
Mailing Address - Country:US
Mailing Address - Phone:530-999-2533
Mailing Address - Fax:530-999-2532
Practice Address - Street 1:2420 SONOMA STREET
Practice Address - Street 2:STE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2536
Practice Address - Country:US
Practice Address - Phone:530-999-2532
Practice Address - Fax:530-999-2533
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4728522084N0400X
CAA1850152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology