Healthcare Provider Details

I. General information

NPI: 1609968601
Provider Name (Legal Business Name): KENNETH JOSEPH HOFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST STE 250
SANTA MONICA CA
90404-2052
US

IV. Provider business mailing address

1301 20TH ST STE 250
SANTA MONICA CA
90404-2052
US

V. Phone/Fax

Practice location:
  • Phone: 310-451-2020
  • Fax:
Mailing address:
  • Phone: 310-451-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG017108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: