Healthcare Provider Details

I. General information

NPI: 1720260474
Provider Name (Legal Business Name): KENNETH K TEMEKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KENNETH K TEMEKI ORTHOTIST/PROSTHETIS

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 155TH ST SUITE 106
GARDENA CA
90247-4048
US

IV. Provider business mailing address

1125 E 17TH ST STE N354
SANTA ANA CA
92701-2269
US

V. Phone/Fax

Practice location:
  • Phone: 310-358-4596
  • Fax:
Mailing address:
  • Phone: 714-852-3756
  • Fax: 714-852-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: