Provider Demographics
NPI:1326175597
Name:BAILEY, KENNETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:BAILEY
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 1:5251 OFFICE PARK DR
Mailing Address - Street 2:STE. 202
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0404
Mailing Address - Country:US
Mailing Address - Phone:661-829-0074
Mailing Address - Fax:661-200-7783
Practice Address - Street 1:5020 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0631
Practice Address - Country:US
Practice Address - Phone:661-324-4100
Practice Address - Fax:661-324-4600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7551174400000X
CA146475208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000009881OtherBLUE CROSS BLUE SHIELD
MT152235Medicaid
MT000009881OtherBLUE CROSS BLUE SHIELD
MTG09614Medicare UPIN