Healthcare Provider Details

I. General information

NPI: 1871707984
Provider Name (Legal Business Name): KENNETH S. BLUMENFELD, MD. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR SUITE 710
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

2577 SAMARITAN DR SUITE 710
SAN JOSE CA
95124-4100
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-0133
  • Fax: 408-358-8134
Mailing address:
  • Phone: 408-358-0133
  • Fax: 408-358-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH S. BLUMENFELD
Title or Position: M.D.
Credential: M.D.
Phone: 408-358-0133