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NPI Code Detail

MEDICARE: DR. KENNETH STARR M.D.

MEDICARE: DR. KENNETH STARR 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
1207P00000XEmergency Medicine PhysicianMD22323OOR
2207RA0401XAddiction Medicine (Internal Medicine) PhysicianA105044CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H00866OTHERCHAMPUS
2H00866OTHERLIPA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5H00866OTHERGROUP HEALTH
6057221014OTHERBCBS
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8A032OTHERCHAMPUS

General Provider Information

NPI Number : 1861431595
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH STARR M.D.
Provider Business Mailing Address
First Line : 105 S MAIN ST
Second Line :
City : TEMPLETON
State : CA
Zip : 93465-9601
Country : US
Telephone Number : 805-434-1869
Fax Number :
Provider Business Practice Location Address
First Line : 107 NELSON ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420-3318
Country : US
Telephone Number : 805-242-1360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/21/2022

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Directions to “ DR. KENNETH STARR M.D.” Practice Location

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