Basic Information
| Provider Information | |||||||||
| NPI: | 1801392428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAN | ||||||||
| FirstName: | MARIE DENISE | ||||||||
| MiddleName: | BANARES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 SHOREWAY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940024110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505967000 | ||||||||
| FaxNumber: | 6505937093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A174547 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.