MEDICARE: DR. KENNETH ANDREW KATZ MD, MSC, MSCE

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
1	207N00000X	Dermatology Physician	A101448	CA

General Provider Information

NPI Number	:	1134141583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ANDREW KATZ MD, MSC, MSCE

Provider Business Mailing Address
First Line	:	3851 ROSECRANS ST STE 207
Second Line	:	COUNTY OF SAN DIEGO, HHSA/HSHB
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3115
Country	:	US
Telephone Number	:	619-692-8394
Fax Number	:	619-296-2688

Provider Business Practice Location Address
First Line	:	3851 ROSECRANS ST STE 207
Second Line	:	COUNTY OF SAN DIEGO, HHSA/HSHB
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-3115
Country	:	US
Telephone Number	:	619-692-8394
Fax Number	:	619-296-2688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	12/14/2021

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