Healthcare Provider Details

I. General information

NPI: 1770519373
Provider Name (Legal Business Name): KENNETH MITCHELL TOFT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 RESERVE DR
ROSEVILLE CA
95678-1340
US

IV. Provider business mailing address

959 RESERVE DR
ROSEVILLE CA
95678-1340
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-8638
  • Fax: 916-782-8662
Mailing address:
  • Phone: 916-782-8638
  • Fax: 916-782-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA00055090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: