Basic Information
| Provider Information | |||||||||
| NPI: | 1427179969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KENNETH L SAUL MD, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH OAKS PEDIATRIC MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 HAALAND DRIVE | ||||||||
| Address2: | #104 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913613003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054941948 | ||||||||
| FaxNumber: | 8054941947 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 HAALAND DRIVE | ||||||||
| Address2: | #104 | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913613003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054941948 | ||||||||
| FaxNumber: | 8054941947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAUL | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8054941948 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G43044 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | ZZZ564032 | 01 | CA | BLUE SHIELD - CA | OTHER |