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General NPI Number Information
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NPI Number | 1386633964
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Entity Type | Individual
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Provider Name | KEN A MCGINNIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 840 MITTEN RD
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City | BURLINGAME
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State | CA
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Zip | 94010-1304
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Country | US
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Telephone | 650-342-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 55 W 5TH AVE 9A
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City | SAN MATEO
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State | CA
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Zip | 94402-2066
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C34492
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License Number State | CA
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