MEDICARE: KARDEA OWENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	35532	CA

General Provider Information

NPI Number	:	1720812241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARDEA OWENS

Provider Business Mailing Address
First Line	:	39540 BAINBRIDGE CIR
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-6834
Country	:	US
Telephone Number	:	760-672-4113
Fax Number	:

Provider Business Practice Location Address
First Line	:	36068 HIDDEN SPRINGS RD
Second Line	:
City	:	WILDOMAR
State	:	CA
Zip	:	92595-7679
Country	:	US
Telephone Number	:	760-672-4113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

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