Kenzie Bohnsack

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

400 Paul Scannell Dr
San Mateo, CA 94402-4062

Phone

(650) 312-8970

NPI assigned

Sep 21, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kenzie Goedken Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1548718307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 ELM ST STE 212",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940703070",
            "telephone_number": "650-591-9623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 PAUL SCANNELL DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944024062",
            "telephone_number": "650-312-8970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "609 Price Ave Ste 205",
            "address_purpose": "LOCATION",
            "city": "Redwood City",
            "state": "CA",
            "postal_code": "940631403",
            "country_code": "US",
            "telephone_number": "650-366-8436",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2005 Asbury Rd",
            "address_purpose": "LOCATION",
            "city": "Dubuque",
            "state": "IA",
            "postal_code": "520013042",
            "country_code": "US",
            "telephone_number": "563-583-7357",
            "fax_number": "563-583-7026",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOHNSACK",
        "first_name": "KENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENZIE",
            "last_name": "GOEDKEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Student in an Organized Health Care Education/Training Program in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.