MEDICARE: KENNARD DAVID BEARD P.A.

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	363AS0400X	Surgical Physician Assistant	PA20918	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588960694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNARD DAVID BEARD P.A.

Provider Business Mailing Address
First Line	:	440 DAVIS CT
Second Line	:	APT 311
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-2445
Country	:	US
Telephone Number	:	415-517-4047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 N CALIFORNIA BLVD
Second Line	:	SUITE 400
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-3742
Country	:	US
Telephone Number	:	925-225-5837
Fax Number	:

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	09/13/2013

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