Provider Demographics
NPI:1073778213
Name:KENNETH F. BINMOELLER, MD INC
Entity Type:Organization
Organization Name:KENNETH F. BINMOELLER, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BINMOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-600-1151
Mailing Address - Street 1:3116 W MARCH LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2369
Mailing Address - Country:US
Mailing Address - Phone:209-473-6555
Mailing Address - Fax:209-473-6544
Practice Address - Street 1:2333 BUCHANAN ST
Practice Address - Street 2:5TH FLOOR GI LAB
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1925
Practice Address - Country:US
Practice Address - Phone:415-600-1151
Practice Address - Fax:415-600-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49767207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497670Medicaid
CA1851321715OtherNPI NUMBER
CAA049767OtherCA MD LICENSE
CA1851321715OtherNPI NUMBER