Healthcare Provider Details

I. General information

NPI: 1336127315
Provider Name (Legal Business Name): FREDERIC C. KASS, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GRAY AVE STE 100
SANTA BARBARA CA
93101-1800
US

IV. Provider business mailing address

121 GRAY AVE STE 200
SANTA BARBARA CA
93101-1800
US

V. Phone/Fax

Practice location:
  • Phone: 805-679-6750
  • Fax: 805-879-9014
Mailing address:
  • Phone: 805-679-6750
  • Fax: 805-879-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERIC CHARLES KASS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-679-6750