Individual
KENNETH CHARLES HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9220 SILVERWOOD CT, GRANITE BAY, CA 95746-7242
(916) 337-0511
Mailing address
9220 SILVERWOOD CT, GRANITE BAY, CA 95746-7242
(916) 337-0511
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A44882
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A448820
BLUE SHIELD
CA
05
—
00A448820
—
CA
Enumeration date
07/31/2006
Last updated
06/30/2014
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