Provider Demographics
NPI:1679646533
Name:KRAFT, JOHN KERSTEN (M D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KERSTEN
Last Name:KRAFT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 SAMARITAN DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-358-2030
Mailing Address - Fax:408-358-2036
Practice Address - Street 1:2581 SAMARITAN DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-358-2030
Practice Address - Fax:408-358-2036
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG23536208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G235362Medicare ID - Type Unspecified
A41983Medicare UPIN