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NPI Code Detail

MEDICARE: MR. KENNETH ANDREW

MEDICARE: MR. KENNETH ANDREW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1326335118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KENNETH ANDREW
Provider Business Mailing Address
First Line : 720 S 3RD ST APT 7
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-5863
Country : US
Telephone Number : 408-903-0922
Fax Number :
Provider Business Practice Location Address
First Line : 102 S 11TH ST
Second Line :
City : SAN JOSE
State : CA
Zip : 95112-2132
Country : US
Telephone Number : 408-903-0922
Fax Number : 408-885-1366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 06/07/2023

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Directions to “ MR. KENNETH ANDREW ” Practice Location

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