Provider Demographics
NPI:1811230592
Name:HIRSCH, KENNETH DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DONALD
Last Name:HIRSCH
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 1:25 TAM O SHANTER RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1737
Mailing Address - Country:US
Mailing Address - Phone:925-820-2093
Mailing Address - Fax:
Practice Address - Street 1:25 TAM O SHANTER RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1737
Practice Address - Country:US
Practice Address - Phone:925-820-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30148207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology