| Doctor Name: | DR. KENT HAGEN |
| NPI Number: | 1184985806 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C29501 |
| Business Practice Address: | 250 Hospital Pkwy San Jose, CA - 951191103 |
| Business Phone Number: | 9252546444 |
| Business Fax Number: | 9252546456 |
| Mailing Address: | P.o. Box 2143, ORINDA |
| State: | CA |
| Postal Code: | 945633421 |
| Phone Number: | 9252546444 |
| Fax Number: | 9252546456 |
| NPI Enumeration Date: | 05/30/2012 |
| NPI Last Update Date: | 06/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C29501 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |