Provider Demographics
NPI:1851321715
Name:BINMOELLER, KENNETH F (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:BINMOELLER
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:DEPT 34754
Mailing Address - Street 2:PO BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:415-600-1151
Mailing Address - Fax:415-447-6330
Practice Address - Street 1:1101 VAN NESS AVE RM 31583
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-1151
Practice Address - Fax:415-447-6330
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153934207R00000X
CAA49767207RG0100X
CAA049767207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497670Medicaid
CAA049767OtherSTATE LICENSE #
CA00A497670Medicare ID - Type Unspecified
CAC98720Medicare UPIN