MEDICARE: MR. KENNETH MITCHELL TOFT 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
1	207YS0123X	Facial Plastic Surgery Physician	A00055090	CA

General Provider Information

NPI Number	:	1770519373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH MITCHELL TOFT M.D.

Provider Business Mailing Address
First Line	:	959 RESERVE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-1340
Country	:	US
Telephone Number	:	916-782-8638
Fax Number	:	916-782-8662

Provider Business Practice Location Address
First Line	:	959 RESERVE DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-1340
Country	:	US
Telephone Number	:	916-782-8638
Fax Number	:	916-782-8662

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/08/2007

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