Provider Demographics
NPI:1174600365
Name:HAMMERMAN, KENNETH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:HAMMERMAN
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 1:1199 BUSH STREET
Mailing Address - Street 2:SUITE #500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-673-7600
Mailing Address - Fax:415-673-8065
Practice Address - Street 1:1199 BUSH STREET
Practice Address - Street 2:SUITE #500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-673-7600
Practice Address - Fax:415-673-8065
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25963207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10W02904OtherMEDICARE RR
CY0128OtherMEDICARE RR
CA00G259630Medicaid
10W02904OtherMEDICARE RR
CA00G259630Medicaid