Provider Demographics
NPI:1346437787
Name:ETEFIA, KENNETH KEHINDE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:KEHINDE
Last Name:ETEFIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 S AMPHLETT BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2515
Mailing Address - Country:US
Mailing Address - Phone:650-206-8932
Mailing Address - Fax:855-347-9258
Practice Address - Street 1:1650 S AMPHLETT BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2515
Practice Address - Country:US
Practice Address - Phone:650-206-8932
Practice Address - Fax:855-347-9258
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1084532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry