Provider Demographics
NPI:1801816442
Name:HALE, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HALE
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 1:3200 21ST ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3108
Mailing Address - Country:US
Mailing Address - Phone:661-334-1958
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:420 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2237
Practice Address - Country:US
Practice Address - Phone:661-327-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57784207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G577840Medicaid
CA00G577841Medicare PIN
CA00G577846Medicare UPIN
CA050049916Medicare PIN
CAZZZ15998ZMedicare PIN
CAZZZ21365ZMedicare PIN
CA00G577840Medicare PIN
CA00G577840Medicaid
CA00G577843Medicare PIN
CA00G577844Medicare PIN
CAE72093Medicare UPIN
CA00G577845Medicare PIN
CAZZZ34009ZMedicare PIN
CACD4582Medicare PIN
CAZZZ21366ZMedicare PIN
CAZZZ21367ZMedicare PIN
CA00G577842Medicare PIN