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NPI Code Detail

MEDICARE: KENNETH ANDREW ANTONS M.D.

MEDICARE: KENNETH ANDREW ANTONS 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
1207R00000XInternal Medicine PhysicianA84454CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982668182
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH ANDREW ANTONS M.D.
Provider Business Mailing Address
First Line : 4405 VANDEVER AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-3315
Country : US
Telephone Number : 800-290-5000
Fax Number :
Provider Business Practice Location Address
First Line : 4405 VANDEVER AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92120-3315
Country : US
Telephone Number : 800-290-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 12/01/2021

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