Healthcare Provider Details

I. General information

NPI: 1396613485
Provider Name (Legal Business Name): KANO BABAGUCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 E CESAR CHAVEZ BLVD
FRESNO CA
93727
US

IV. Provider business mailing address

4879 E CESAR CHAVEZ BLVD
FRESNO CA
93727
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: