Provider Demographics
NPI:1497783351
Name:HERBST, KENNETH DOWNARD (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DOWNARD
Last Name:HERBST
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 1:5761 LA JOLLA HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7330
Mailing Address - Country:US
Mailing Address - Phone:858-456-2633
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-471-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20622207RH0003X, 207RH0000X, 207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Not Answered207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine