Healthcare Provider Details

I. General information

NPI: 1700714185
Provider Name (Legal Business Name): KENNETH MITCHELL SIGELMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE FL 2
SAN DIEGO CA
92101-2382
US

IV. Provider business mailing address

1901 1ST AVE FL 2
SAN DIEGO CA
92101-2382
US

V. Phone/Fax

Practice location:
  • Phone: 619-238-3813
  • Fax: 619-238-1866
Mailing address:
  • Phone: 619-238-3813
  • Fax: 619-238-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG48809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: