Kenneth Kehinde Etefia, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

A108453 Issued in CA

Practice address

1650 S Amphlett Blvd Ste 203
San Mateo, CA 94402-2515

Phone

(650) 206-8932

Fax

(855) 347-9258

NPI assigned

Oct 1, 2007

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 Apr 1, 2026 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Renaissance Behavioral Medicine

  • Psychiatry Physician
  • Beverly Hills, CA
  • NPI 1750964722
  NPD (past) Authorized official

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1346437787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 S AMPHLETT BLVD STE 203",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022515",
            "telephone_number": "650-206-8932",
            "fax_number": "855-347-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S AMPHLETT BLVD STE 203",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944022515",
            "telephone_number": "650-206-8932",
            "fax_number": "855-347-9258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1036 Sir Francis Drake Blvd",
            "address_purpose": "LOCATION",
            "city": "Kentfield",
            "state": "CA",
            "postal_code": "949041427",
            "country_code": "US",
            "telephone_number": "415-361-8065",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETEFIA",
        "first_name": "KENNETH",
        "middle_name": "KEHINDE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-01",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A108453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine S Estrada, LCSW
• Robin Barbara Price Estrada, PSY.D.
• Sarah Estrada
• Liliana M Estrella
• Chidimma Etchenwune
• Arnell Ruby Etherington, PH.D.
• Jonathan Etkin
• Yarnel Evangelista
• Carly Elizabeth Evans
• Tomoko Evans

• Psychiatry Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2021; 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.