Healthcare Provider Details

I. General information

NPI: 1366972564
Provider Name (Legal Business Name): NICOLE KENDALL WARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 S ATLANTIC BLVD STE 300
MONTEREY PARK CA
91754-6366
US

IV. Provider business mailing address

2629 FOOTHILL BLVD # 305
LA CRESCENTA CA
91214-3511
US

V. Phone/Fax

Practice location:
  • Phone: 818-806-8830
  • Fax: 818-536-7695
Mailing address:
  • Phone: 310-948-3987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: