Healthcare Provider Details

I. General information

NPI: 1023997541
Provider Name (Legal Business Name): KAI DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BAYONET CIR
MARINA CA
93933-4600
US

IV. Provider business mailing address

617 BAYONET CIR
MARINA CA
93933-4600
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: