Healthcare Provider Details

I. General information

NPI: 1366768541
Provider Name (Legal Business Name): DR. KENNETH S POON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED ST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

2500 MERCED ST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER
SAN LEANDRO CA
94577-4201
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-2760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberDR.0077442
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA139907
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number268932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: