Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 00G579000 | CA |
NPI | 1912962556 |
---|---|
Provider Name | Dr. Jeffrey Scott Kanel |
First Address | Los Gatos, CA 95032-1418 |
Second Address | Los Gatos, CA 95032-1418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 22/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G579000 | (05) | CA |
F26268 | (02) | CA |
ZZZ29917Z | MEDICARE PTAN (01) | CA |