Provider Demographics
NPI:1942374905
Name:TAI, KENNETH BORKANG (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BORKANG
Last Name:TAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1520 STOCKTON STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:415-391-9686
Mailing Address - Fax:415-433-1139
Practice Address - Street 1:1520 STOCKTON STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:415-391-9686
Practice Address - Fax:415-433-1139
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91670207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A916700OtherPPIN
CA00A916700OtherPPIN
I35360Medicare UPIN