Healthcare Provider Details

I. General information

NPI: 1013021708
Provider Name (Legal Business Name): WILLIAM KENNETH HALLIDAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 W BEVERLY BLVD
MONTEBELLO CA
90640-2306
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 323-201-4130
  • Fax: 323-201-4134
Mailing address:
  • Phone: 562-977-4674
  • Fax: 562-741-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA23526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: