Provider Demographics
NPI:1467933739
Name:BEMBEY, KANIKA (DDS)
Entity Type:Individual
Prefix:
First Name:KANIKA
Middle Name:
Last Name:BEMBEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34483 ALBERTA TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2908
Mailing Address - Country:US
Mailing Address - Phone:805-312-5161
Mailing Address - Fax:
Practice Address - Street 1:2808 W MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-8409
Practice Address - Country:US
Practice Address - Phone:209-667-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty