MEDICARE: DR. KENNETH JOHN HILL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	G73908	CA
2	207Q00000X	Family Medicine Physician	G73908	CA

General Provider Information

NPI Number	:	1629020953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH JOHN HILL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5486
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-5486
Country	:	US
Telephone Number	:	818-550-0900
Fax Number	:	505-293-1524

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	STE 300
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-623-5310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/10/2014

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