Provider Demographics
NPI:1861456246
Name:KENT, GEORGE PETER (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PETER
Last Name:KENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-995-5453
Mailing Address - Fax:408-275-9442
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-995-5453
Practice Address - Fax:408-275-9442
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464210Medicaid
CA00G464210Medicaid
CA00G464212Medicare ID - Type Unspecified