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General NPI Number Information
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NPI Number | 1003111410
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Entity Type | Organization
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Legal Business Name | KENNETH T ROOST MD INC
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 1828 EL CAMINO REAL #604
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City | BURLINGAME
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State | CA
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Zip | 94010-3103
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Country | US
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Telephone | 650-697-9146
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Fax |
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Provider Business Mailing Address
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Address Line | 1828 EL CAMINO REAL #604
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City | BURLINGAME
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State | CA
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Zip | 94010-3103
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Country | US
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Telephone | 650-697-9146
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH TAYLOR ROOST
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Credential | MD
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Telephone | 650-697-9146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G27727
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License Number State | CA
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