Provider Demographics
NPI:1487544581
Name:WUBNEH, MISGANAW KASSIE
Entity type:Individual
Prefix:
First Name:MISGANAW
Middle Name:KASSIE
Last Name:WUBNEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8416 W WING DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-9558
Mailing Address - Country:US
Mailing Address - Phone:916-309-9753
Mailing Address - Fax:
Practice Address - Street 1:8416 W WING DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-9558
Practice Address - Country:US
Practice Address - Phone:916-309-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-02427036246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant