Provider Demographics
NPI:1295919868
Name:KPT MEDHEALTH CORP.
Entity type:Organization
Organization Name:KPT MEDHEALTH CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-663-9094
Mailing Address - Street 1:6001 TRUXTUN AVE
Mailing Address - Street 2:SUITE 320C
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0679
Mailing Address - Country:US
Mailing Address - Phone:661-663-9094
Mailing Address - Fax:661-663-9098
Practice Address - Street 1:6001 TRUXTUN AVENUE
Practice Address - Street 2:SUITE 320C
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0679
Practice Address - Country:US
Practice Address - Phone:661-663-9094
Practice Address - Fax:661-663-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG397580207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47948Medicare UPIN