Provider Demographics
NPI:1073987087
Name:KRANTZ, KENNETH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E 2ND AVE
Mailing Address - Street 2:SUITE 519
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3963
Mailing Address - Country:US
Mailing Address - Phone:650-888-9639
Mailing Address - Fax:650-401-6611
Practice Address - Street 1:204 E 2ND AVE
Practice Address - Street 2:SUITE 519
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3963
Practice Address - Country:US
Practice Address - Phone:650-888-9639
Practice Address - Fax:650-401-6611
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG392271744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study