Provider Demographics
NPI:1285615922
Name:HAMANN, KENDAL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KENDAL
Middle Name:LEE
Last Name:HAMANN
Suffix:
Gender:F
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:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:707-521-7735
Mailing Address - Fax:707-573-5422
Practice Address - Street 1:3883 AIRWAY DR STE 201
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1671
Practice Address - Country:US
Practice Address - Phone:707-521-7735
Practice Address - Fax:707-573-5422
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81803207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A818030Medicare ID - Type Unspecified
CAI05133Medicare UPIN