Provider Demographics
NPI:1114046240
Name:GANDY, KENNETH BERNARD (MA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BERNARD
Last Name:GANDY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 TWIN CREEKS LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3629
Mailing Address - Country:US
Mailing Address - Phone:916-797-3789
Mailing Address - Fax:
Practice Address - Street 1:3004 TWIN CREEKS LN
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3629
Practice Address - Country:US
Practice Address - Phone:916-797-3789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist