Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101238231 | VA |
Y | 207Q00000X | Family Doctor | C161212 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | 0101238231 | VA |
NPI | 1295707784 |
---|---|
Provider Name | Robert G Kennedy |
First Address | San Francisco, CA 94107-5705 |
Second Address | San Francisco, CA 94107-5705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010160367 | (05) | VA |
010160367 | VA PREMIER (01) | VA |
179367 | ANTHEM (01) | VA |
315335 | SOUTHERN HEALTH (01) | VA |
5630042 | FIRST HEALTH (01) | VA |
97250 | OPTIMA (01) | VA |
I17131 | (02) | VA |
VVE6439975 | MEDICARE PTAN-AHWI (01) | VA |