MEDICARE: DR. KENNETH ALBERT BIANCHI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26036	CA

General Provider Information

NPI Number	:	1104958016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ALBERT BIANCHI DDS

Provider Business Mailing Address
First Line	:	2401 OCEAN AVENUE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94127-2606
Country	:	US
Telephone Number	:	415-334-0421
Fax Number	:	415-334-5716

Provider Business Practice Location Address
First Line	:	2401 OCEAN AVENUE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94127-2606
Country	:	US
Telephone Number	:	415-334-0421
Fax Number	:	415-334-5716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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