Provider Demographics
NPI:1548718307
Name:BOHNSACK, KENZIE
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:BOHNSACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:
Other - Last Name:GOEDKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 ELM ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3070
Mailing Address - Country:US
Mailing Address - Phone:650-591-9623
Mailing Address - Fax:
Practice Address - Street 1:400 PAUL SCANNELL DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4062
Practice Address - Country:US
Practice Address - Phone:650-312-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program