Provider Demographics
NPI:1164441960
Name:ROSENFELD, KENNETH EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EVAN
Last Name:ROSENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2350
Mailing Address - Country:US
Mailing Address - Phone:415-885-7671
Mailing Address - Fax:415-353-9522
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:VAGLAHS (MAIL CODE 111G)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4933
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78614207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF55437Medicare UPIN