Provider Demographics
NPI:1912535485
Name:OBA, KEN (DO)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:OBA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 2ND ST STE 1230
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1587
Mailing Address - Country:US
Mailing Address - Phone:775-260-2471
Mailing Address - Fax:775-357-8042
Practice Address - Street 1:300 E 2ND ST STE 1230
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1587
Practice Address - Country:US
Practice Address - Phone:775-260-2471
Practice Address - Fax:775-357-8042
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO3696207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program