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General NPI Number Information
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NPI Number | 1104772862
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Entity Type | Organization
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Legal Business Name | KNGDM SERVICES
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 2110 FOREST AVE
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City | SAN JOSE
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State | CA
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Zip | 95128-1469
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Country | US
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Telephone | 408-297-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 17081 PISTACHE DR
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City | MORGAN HILL
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State | CA
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Zip | 95037-7246
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Country | US
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Telephone | 408-823-2070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONNIE COMIA VILLANUEVA
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Credential | BS RN CNOR RNFA
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Telephone | 408-823-2070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number |
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License Number State |
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