Provider Demographics
NPI:1427179969
Name:KENNETH L SAUL MD, INC.
Entity Type:Organization
Organization Name:KENNETH L SAUL MD, INC.
Other - Org Name:NORTH OAKS PEDIATRIC MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-494-1948
Mailing Address - Street 1:425 HAALAND DRIVE
Mailing Address - Street 2:#104
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3003
Mailing Address - Country:US
Mailing Address - Phone:805-494-1948
Mailing Address - Fax:805-494-1947
Practice Address - Street 1:425 HAALAND DRIVE
Practice Address - Street 2:#104
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-3003
Practice Address - Country:US
Practice Address - Phone:805-494-1948
Practice Address - Fax:805-494-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ564032OtherBLUE SHIELD - CA