Provider Demographics
NPI:1336233147
Name:JESSER, KENNETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:JESSER
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 1:44530 SAN PABLO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3597
Mailing Address - Country:US
Mailing Address - Phone:760-341-7563
Mailing Address - Fax:760-341-7564
Practice Address - Street 1:44530 SAN PABLO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3597
Practice Address - Country:US
Practice Address - Phone:760-341-7563
Practice Address - Fax:760-341-7564
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44813174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE65323Medicare UPIN
CAZZZ26374ZMedicare ID - Type Unspecified