Provider Demographics
NPI:1265406268
Name:WEINSTOCK, KEN (MD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:WEINSTOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7570
Practice Address - Street 1:2001 N ST STE 210
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4237
Practice Address - Country:US
Practice Address - Phone:916-508-4069
Practice Address - Fax:844-965-9375
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA927872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN