Provider Demographics
NPI:1245568252
Name:KUBENDRAN, SHOBANA (MBBS, MS, CGC)
Entity type:Individual
Prefix:
First Name:SHOBANA
Middle Name:
Last Name:KUBENDRAN
Suffix:
Gender:F
Credentials:MBBS, MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47490
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7490
Mailing Address - Country:US
Mailing Address - Phone:316-962-3150
Mailing Address - Fax:316-962-7334
Practice Address - Street 1:3243 E MURDOCK ST
Practice Address - Street 2:SUITE 500
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3052
Practice Address - Country:US
Practice Address - Phone:316-962-3070
Practice Address - Fax:316-962-3081
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS