Healthcare Provider Details

I. General information

NPI: 1295993459
Provider Name (Legal Business Name): KENNETH ALAN KERN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10646 SCIENCE CENTER DR
SAN DIEGO CA
92121-1150
US

IV. Provider business mailing address

10646 SCIENCE CENTER DR
SAN DIEGO CA
92121-1150
US

V. Phone/Fax

Practice location:
  • Phone: 610-405-2685
  • Fax:
Mailing address:
  • Phone: 610-405-2685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberG87349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: