MEDICARE: PHILLIP LEE KINTNER MD

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	207V00000X	Obstetrics & Gynecology Physician	G88574	CA

General Provider Information

NPI Number	:	1578559084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP LEE KINTNER MD

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	280 SIERRA COLLEGE DR STE 115
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5763
Country	:	US
Telephone Number	:	530-477-3119
Fax Number	:	530-274-2077

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	11/01/2021

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