Provider Demographics
NPI:1801059258
Name:KINOSHITA, KEN (MD)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:KINOSHITA
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 1:238 SPRING ST
Mailing Address - Street 2:A
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2115
Mailing Address - Country:US
Mailing Address - Phone:973-862-6650
Mailing Address - Fax:
Practice Address - Street 1:238 SPRING ST
Practice Address - Street 2:A
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2115
Practice Address - Country:US
Practice Address - Phone:973-862-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119518207Q00000X
NJ25MA09446100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine