Individual
KANDICE RENEE BEENKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3750 CONVOY ST STE 201, SAN DIEGO, CA 92111-3770
(858) 278-8031
(858) 278-1708
Mailing address
3750 CONVOY ST STE 201, SAN DIEGO, CA 92111-3770
(858) 278-8031
(858) 278-1708
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
20A15340
CA
207X00000X
Orthopaedic Surgery Physician
5101019407
MI
207X00000X
Orthopaedic Surgery Physician
DO2030
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982991501
—
NV
01
—
20A15340
CA MEDICAL LICENSE
CA
01
—
5101019407
MEDICAL LICENSE NUMBER
MI
01
—
DO2030
NV MEDICAL LICENSE
NV
Enumeration date
07/04/2011
Last updated
07/21/2022
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