Provider Demographics
NPI:1710739073
Name:KIN FOOT AND ANKLE
Entity Type:Organization
Organization Name:KIN FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHIBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-261-1561
Mailing Address - Street 1:400 CYPRESS AVE UNIT 705
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3799
Mailing Address - Country:US
Mailing Address - Phone:916-261-1561
Mailing Address - Fax:
Practice Address - Street 1:3400 COTTAGE WAY STE G2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-1474
Practice Address - Country:US
Practice Address - Phone:916-261-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty