Healthcare Provider Details

I. General information

NPI: 1639175672
Provider Name (Legal Business Name): KENNETH DALE KRONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 ROCK WREN LN
AVILA BEACH CA
93424-3536
US

IV. Provider business mailing address

PO BOX 2605
AVILA BEACH CA
93424-2605
US

V. Phone/Fax

Practice location:
  • Phone: 805-627-1713
  • Fax: 888-691-8259
Mailing address:
  • Phone: 805-627-1713
  • Fax: 888-691-8259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG23988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: