Healthcare Provider Details

I. General information

NPI: 1356501415
Provider Name (Legal Business Name): KENNETH ALBERT HUTCHINS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 FLOWER ST
BAKERSFIELD CA
93305-4144
US

IV. Provider business mailing address

5013 SHADOW LAKE DR
BAKERSFIELD CA
93313-4367
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2000
  • Fax:
Mailing address:
  • Phone: 661-665-8287
  • Fax: 661-665-8287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: