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NPI Code Detail

MEDICARE: DR. KYLEE A HOMECILLO DMD, MPH

MEDICARE: DR. KYLEE A HOMECILLO DMD, MPH
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
1390200000XStudent in an Organized Health Care Education/Training ProgramCA
2122300000XDentist108946CA

General Provider Information

NPI Number : 1154019628
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYLEE A HOMECILLO DMD, MPH
Provider Business Mailing Address
First Line : 1926 E 19TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4126
Country : US
Telephone Number : 510-535-2893
Fax Number :
Provider Business Practice Location Address
First Line : 1926 E 19TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94606-4126
Country : US
Telephone Number : 510-535-3921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2023
Last Update Date : 08/26/2024

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