Provider Demographics
NPI:1518522317
Name:EGBUJOR, KINGSLEY C
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:C
Last Name:EGBUJOR
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 1:1661 AVENIDA DE LOS PADRES
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2961
Mailing Address - Country:US
Mailing Address - Phone:925-997-6521
Mailing Address - Fax:
Practice Address - Street 1:1661 AVENIDA DE LOS PADRES
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2961
Practice Address - Country:US
Practice Address - Phone:925-997-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator