MEDICARE: DR. MARTIN L KABONGO MD, APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A55012	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033168810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN L KABONGO MD, APC

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:	858-249-6749
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5749
Country	:	US
Telephone Number	:	323-923-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/26/2024

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