Provider Demographics
NPI:1437554979
Name:MARTIN KABONGO, M.D., APC
Entity Type:Organization
Organization Name:MARTIN KABONGO, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KABONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-861-5314
Mailing Address - Street 1:1040 TIERRA DEL REY STE 107
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7865
Mailing Address - Country:US
Mailing Address - Phone:619-248-9555
Mailing Address - Fax:619-479-6726
Practice Address - Street 1:1040 TIERRA DEL REY STE 107
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7865
Practice Address - Country:US
Practice Address - Phone:619-248-9555
Practice Address - Fax:619-479-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty