Healthcare Provider Details

I. General information

NPI: 1205830890
Provider Name (Legal Business Name): KENNETH STEVEN ALPERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W COMMONWEALTH AVE
FULLERTON CA
92833-2727
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA49395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: