Provider Demographics
NPI:1386860765
Name:KWABENA ADUBOFOUR, MD INC
Entity Type:Organization
Organization Name:KWABENA ADUBOFOUR, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUBOFOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-249-9497
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:209-845-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA52394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523940Medicaid
CA00A523940Medicaid