Basic Information
Provider Information
NPI: 1720037633
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KURZ
FirstName: BENEDIKT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3687 MT DIABLO BLVD
Address2: #200
City: LAFAYETTE
State: CA
PostalCode: 945493717
CountryCode: US
TelephoneNumber: 5102046660
FaxNumber: 9252996849
Practice Location
Address1: 20101 LAKE CHABOT RD
Address2:  
City: CASTRO VALLEY
State: CA
PostalCode: 945465305
CountryCode: US
TelephoneNumber: 5108863400
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2006
LastUpdateDate: 12/01/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000XA81945CAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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