Provider Demographics
NPI:1083715254
Name:CHARN, KENNY K (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:K
Last Name:CHARN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5406
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-0008
Mailing Address - Country:US
Mailing Address - Phone:209-223-1194
Mailing Address - Fax:209-223-1196
Practice Address - Street 1:201 CLINTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2648
Practice Address - Country:US
Practice Address - Phone:209-223-1194
Practice Address - Fax:209-223-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG68975207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G689751Medicare PIN
CAF69905Medicare UPIN