Healthcare Provider Details

I. General information

NPI: 1700038718
Provider Name (Legal Business Name): CHARLES KEN HOYT VII BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CUMMINS DR # B2
MODESTO CA
95358-6400
US

IV. Provider business mailing address

2902 BLACKSAND CREEK WAY
RIVERBANK CA
95367-9451
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-1750
  • Fax: 209-576-1768
Mailing address:
  • Phone: 209-657-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: