Provider Demographics
NPI:1093784597
Name:KADDEN, MARK LELAND (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LELAND
Last Name:KADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:120 CRAVEN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4237
Mailing Address - Country:US
Mailing Address - Phone:760-291-6650
Mailing Address - Fax:760-737-3430
Practice Address - Street 1:225 E 2ND AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4245
Practice Address - Country:US
Practice Address - Phone:760-489-0908
Practice Address - Fax:760-489-0962
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2024-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG57198207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G571980Medicaid
CAWG57198BMedicare ID - Type Unspecified
CA00G571980Medicaid