Marshall Ken Kubota, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G43681 Issued in CA

Practice address

495 Tesconi Cir
Santa Rosa, CA 95401-4619

Phone

(707) 419-7904

Fax

(707) 545-2313

NPI assigned

Apr 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328486400000",
    "number": "1245297969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 TESCONI CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014619",
            "telephone_number": "707-419-7904",
            "fax_number": "707-545-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 TESCONI CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014619",
            "telephone_number": "707-419-7904",
            "fax_number": "707-545-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBOTA",
        "first_name": "MARSHALL",
        "middle_name": "KEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2012-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G43681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G436810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher T Krug, PT
• Stephen P Krumland, M.D.
• Ellen Betty Kruusmagi, MD
• Aimee Noelle Krzywicki, REGISTERED CADTP
• Christine W Ku, M.D.
• Dawn Kucker
• Margaret Frances Kuhl, OTD, OTR/L
• Jeffrey Paul Kuhn, MD
• Nicholas Kujala, M.D.
• Patricia Whooley Kulawiak, MD

• Family Medicine Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.