Provider Demographics
NPI:1255816195
Name:KENMED, FIDELIA LAAN
Entity type:Individual
Prefix:
First Name:FIDELIA
Middle Name:LAAN
Last Name:KENMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROUNDTABLE DR APT S3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-4156
Mailing Address - Country:US
Mailing Address - Phone:408-234-6800
Mailing Address - Fax:
Practice Address - Street 1:130 ROUNDTABLE DR APT S3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-4156
Practice Address - Country:US
Practice Address - Phone:408-234-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst