Healthcare Provider Details

I. General information

NPI: 1508817776
Provider Name (Legal Business Name): RICHARD J KANAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

2930 2ND AVE STE 200
MARINA CA
93933-6244
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-3040
  • Fax:
Mailing address:
  • Phone: 831-582-2100
  • Fax: 831-886-1529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG62232
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG62232
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG62232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: