Provider Demographics
NPI:1407066111
Name:KENE, MAMATA VIJAYANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMATA
Middle Name:VIJAYANAND
Last Name:KENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2329
Mailing Address - Country:US
Mailing Address - Phone:619-446-1646
Mailing Address - Fax:619-696-1579
Practice Address - Street 1:2001 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2329
Practice Address - Country:US
Practice Address - Phone:619-446-1646
Practice Address - Fax:619-696-1579
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89638207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine