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Individual

KENNETH WAYNE HART

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1454 E 2ND ST, SAN BERNARDINO, CA 92408-0118
(909) 382-7146
(909) 382-7101
Mailing address
1454 E 2ND ST, SAN BERNARDINO, CA 92408-0118
(909) 382-7146
(909) 382-7101

Taxonomy

Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
G019894
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00G198940
MEDI-CAL PROVIDER NUMBER
CA
01
F141171
INLAND EMPIRE HEALTH PLAN
CA
01
J891171
INLAND EMPIRE HEALTH PLAN
CA
Enumeration date
12/29/2005
Last updated
04/15/2013
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