Provider Demographics
NPI:1689028698
Name:KUBA, CHINAENYEZE
Entity Type:Individual
Prefix:
First Name:CHINAENYEZE
Middle Name:
Last Name:KUBA
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 1:2050 SOUTHWEST EXPY APT 65
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4641
Mailing Address - Country:US
Mailing Address - Phone:408-561-2214
Mailing Address - Fax:
Practice Address - Street 1:14820 MCVAY AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2540
Practice Address - Country:US
Practice Address - Phone:408-258-7343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor