Provider Demographics
NPI:1235158254
Name:BLUMENFELD, KENNETH SANFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SANFORD
Last Name:BLUMENFELD
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 1:2577 SAMARITAN DR
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4100
Mailing Address - Country:US
Mailing Address - Phone:408-358-0133
Mailing Address - Fax:408-358-8134
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:SUITE 710
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-358-0133
Practice Address - Fax:408-358-8134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A509000Medicaid
CAF39066Medicare UPIN
CAZZZ00841ZMedicare PIN