Provider Demographics
NPI:1801850508
Name:ROOST, KENNETH TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:TAYLOR
Last Name:ROOST
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1828 EL CAMINO REAL
Mailing Address - Street 2:STE 604
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3120
Mailing Address - Country:US
Mailing Address - Phone:650-697-9146
Mailing Address - Fax:650-697-5514
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:STE 604
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3120
Practice Address - Country:US
Practice Address - Phone:650-697-9146
Practice Address - Fax:650-697-5514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG27727207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43465Medicare UPIN