MEDICARE: GERALD KENNER M.D.

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	174400000X	Specialist	CFE20266	CA

General Provider Information

NPI Number	:	1356677363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD KENNER M.D.

Provider Business Mailing Address
First Line	:	2800 RALSTON AVE
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-6548
Country	:	US
Telephone Number	:	650-342-1756
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 RALSTON AVE
Second Line	:
City	:	HILLSBOROUGH
State	:	CA
Zip	:	94010-6548
Country	:	US
Telephone Number	:	650-342-1756
Fax Number	:

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

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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