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NPI Code Detail

MEDICARE: KANDICE RENEE BEENKEN D.O.

MEDICARE: KANDICE RENEE BEENKEN D.O.
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
1207X00000XOrthopaedic Surgery Physician5101019407MI
2207X00000XOrthopaedic Surgery PhysicianDO2030NV
3207X00000XOrthopaedic Surgery Physician20A15340CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120A15340OTHERCACA MEDICAL LICENSE
25101019407OTHERMIMEDICAL LICENSE NUMBER
3DO2030OTHERNVNV MEDICAL LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982991501
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANDICE RENEE BEENKEN D.O.
Provider Business Mailing Address
First Line : 3750 CONVOY ST STE 201
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-3770
Country : US
Telephone Number : 858-278-8031
Fax Number : 858-278-1708
Provider Business Practice Location Address
First Line : 3750 CONVOY ST STE 201
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-3770
Country : US
Telephone Number : 858-278-8031
Fax Number : 858-278-1708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2011
Last Update Date : 07/21/2022

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