Individual
KENNETH BANGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1247 E ALLUVIAL AVE, SUITE 101, FRESNO, CA 93720-2686
(559) 431-6226
(559) 440-9005
Mailing address
6042N FRESNO ST 203, FRESNO, CA 93710-5279
(559) 435-1897
(559) 435-1667
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10049
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0170299
STATE OF WASHINGTON
CA
01
—
500030488
RAIL ROAD MEDICARE
CA
Enumeration date
11/15/2005
Last updated
09/09/2015
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