Provider Demographics
NPI:1134138571
Name:KASS, MARTIN BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:BENJAMIN
Last Name:KASS
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 1:130 SHORELINE DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070
Mailing Address - Country:US
Mailing Address - Phone:650-631-1500
Mailing Address - Fax:650-631-1504
Practice Address - Street 1:130 SHORELINE DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070
Practice Address - Country:US
Practice Address - Phone:650-631-1500
Practice Address - Fax:650-631-1504
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31906207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A319061Medicaid
CA00A319061Medicaid
CA00A319062Medicare PIN