Healthcare Provider Details

I. General information

NPI: 1417873688
Provider Name (Legal Business Name): ADAM JOSHUA KATES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR # 705
SAN DIEGO CA
92134-1206
US

IV. Provider business mailing address

3090 POLK AVE APT 705
SAN DIEGO CA
92104-0040
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14281358-8903
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14281358-9923
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: