Provider Demographics
NPI:1467437541
Name:SMITH, KENNETH E (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20126 STANTON AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5271
Mailing Address - Country:US
Mailing Address - Phone:510-537-4211
Mailing Address - Fax:510-537-3345
Practice Address - Street 1:20126 STANTON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5271
Practice Address - Country:US
Practice Address - Phone:510-537-4211
Practice Address - Fax:510-537-3345
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSAU2576231H00000X
KSHTL8430237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS640002892OtherRAILROAD MEDICARE
KSK873678Medicare PIN
KSR62205Medicare UPIN
KS640002892OtherRAILROAD MEDICARE