Healthcare Provider Details

I. General information

NPI: 1336175991
Provider Name (Legal Business Name): DANIEL J. KANADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date: 01/07/2011
Reactivation Date: 10/03/2018

III. Provider practice location address

16075 GREENWOOD RD
MONTE SERENO CA
95030-3016
US

IV. Provider business mailing address

16075 GREENWOOD RD
MONTE SERENO CA
95030-3016
US

V. Phone/Fax

Practice location:
  • Phone: 408-279-3225
  • Fax:
Mailing address:
  • Phone: 408-279-3225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG033555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: