Kenneth Ian Light, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

G35263

Practice address

1700 California St
Suite 340
San Francisco, CA 94109-4586

Phone

(415) 673-4500

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2023 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: klight125814@santaclaravalley.direct-ci.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Global Surgeries, Inc.

  • Prosthetic/Orthotic Supplier
  • San Leandro, CA
  • NPI 1780076398
  NPD
• County of Santa Clara

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063406551

  Multi-Specialty

  NPD (past)
• UCSF Health Community Hospitals

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1316061997
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1104900919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13847 E 14TH ST STE 118",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782625",
            "telephone_number": "415-673-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CALIFORNIA ST",
            "address_2": "SUITE 340",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941094586",
            "telephone_number": "415-673-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "KENNETH",
        "middle_name": "IAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": "G35263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifewave Psychiatry
• Adriana Joanna Liggins
• Hannah Light-Olson, MD
• Holly Grace Light, M.B.A.
• Isabel Light
• Richard Leonard Light
• Adrienne Lightbourne, MD
• Tamara I. Lightfoot, RPH
• Lighthearted Medicine, Inc.
• Lighthouse for the Blind and Visually Impaired

• Specialist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.