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NPI Code Detail

MEDICARE: KENNETH KINNAN MD

MEDICARE: KENNETH KINNAN MD
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
1207L00000XAnesthesiology PhysicianA22729CA

General Provider Information

NPI Number : 1689616278
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH KINNAN MD
Provider Business Mailing Address
First Line : PO BOX 969096
Second Line :
City : SAN DIEGO
State : CA
Zip : 92196-9096
Country : US
Telephone Number : 858-495-0971
Fax Number :
Provider Business Practice Location Address
First Line : 1415 ROSS AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-4306
Country : US
Telephone Number : 760-339-7100
Fax Number : 760-339-7389
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 09/17/2010

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