Basic Information
| Provider Information | |||||||||
| NPI: | 1801844881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASSUBA | ||||||||
| FirstName: | SONJA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108698373 | ||||||||
| FaxNumber: | 5108698375 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HAWTHORNE AVE RM 2346 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108698373 | ||||||||
| FaxNumber: | 5108698375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | C51995 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | C51995 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | C51995 | 01 | CA | STATE MEDICAL LICENSE | OTHER |