Provider Demographics
NPI:1073817326
Name:TODD A KANEN M D MEDICAL CORPORATION
Entity Type:Organization
Organization Name:TODD A KANEN M D MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KANEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-569-3396
Mailing Address - Street 1:5333 HOLLISTER AVE #210
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-3331
Mailing Address - Country:US
Mailing Address - Phone:805-569-3396
Mailing Address - Fax:805-569-3397
Practice Address - Street 1:5333 HOLLISTER AVE STE 210
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-3331
Practice Address - Country:US
Practice Address - Phone:805-569-3396
Practice Address - Fax:805-569-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66159Medicare PIN