Provider Demographics
NPI:1194935858
Name:KUBICKY, CHARLOTTE DAI (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:DAI
Last Name:KUBICKY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CHARLOTTE
Other - Middle Name:YUE
Other - Last Name:DAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PLAZA DR STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3049
Practice Address - Country:US
Practice Address - Phone:916-781-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD276492085R0001X
CAA856642085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology