Healthcare Provider Details

I. General information

NPI: 1982707956
Provider Name (Legal Business Name): KENNETH A HONSIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 225
BERKELEY CA
94705-2190
US

IV. Provider business mailing address

2999 REGENT ST STE 225
BERKELEY CA
94705-2190
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-7760
  • Fax: 510-704-7765
Mailing address:
  • Phone: 510-704-7760
  • Fax: 510-704-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA71509
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA71509
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA71509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: