Provider Demographics
NPI:1548358435
Name:KANEN, NANI
Entity type:Individual
Prefix:MS
First Name:NANI
Middle Name:
Last Name:KANEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:NANI
Other - Middle Name:
Other - Last Name:KANEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1838 EL CAMINO REAL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3126
Mailing Address - Country:US
Mailing Address - Phone:650-697-0361
Mailing Address - Fax:650-697-8752
Practice Address - Street 1:1838 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3126
Practice Address - Country:US
Practice Address - Phone:650-697-0361
Practice Address - Fax:650-697-8752
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A775650Medicaid
CAA77565OtherSTATE LICENSE NUMBER
CABK7937785OtherDEA NUMBER
CA00A775650Medicaid
CABK7937785OtherDEA NUMBER