Individual
KENNETH IMANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G50338
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G503380
—
CA
Enumeration date
04/27/2006
Last updated
08/17/2010
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