Healthcare Provider Details

I. General information

NPI: 1922101963
Provider Name (Legal Business Name): KEN DUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20126 STANTON AVE STE 200
CASTRO VALLEY CA
94546-5270
US

IV. Provider business mailing address

20126 STANTON AVE STE 200
CASTRO VALLEY CA
94546-5270
US

V. Phone/Fax

Practice location:
  • Phone: 510-881-4210
  • Fax: 510-881-4213
Mailing address:
  • Phone: 510-881-4210
  • Fax: 510-881-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG30162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: