Healthcare Provider Details

I. General information

NPI: 1518889203
Provider Name (Legal Business Name): FNU SOUBIYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STATION PARK CIRCLE UNIT 520
SAN MATEO CA
94402
US

IV. Provider business mailing address

400 STATION PARK CIRCLE UNIT 520
SAN MATEO CA
94402
US

V. Phone/Fax

Practice location:
  • Phone: 437-240-8460
  • Fax:
Mailing address:
  • Phone: 437-240-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: