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NPI Code Detail

MEDICARE: DR. EMILY KASSENBROCK M.D.

MEDICARE: DR. EMILY KASSENBROCK M.D.
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
1208000000XPediatrics Physician00G055131CA

General Provider Information

NPI Number : 1598768467
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY KASSENBROCK M.D.
Provider Business Mailing Address
First Line : 10725 INTERNATIONAL DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-7967
Country : US
Telephone Number : 916-631-7440
Fax Number :
Provider Business Practice Location Address
First Line : 10725 INTERNATIONAL DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-7967
Country : US
Telephone Number : 916-631-7334
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 01/10/2022

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