Healthcare Provider Details

I. General information

NPI: 1720225766
Provider Name (Legal Business Name): ADRIENNE DOROTHY KANE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

IV. Provider business mailing address

3130 BALFOUR RD STE D-104
BRENTWOOD CA
94513-5515
US

V. Phone/Fax

Practice location:
  • Phone: 888-530-4415
  • Fax: 844-226-9193
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: