Healthcare Provider Details

I. General information

NPI: 1306379359
Provider Name (Legal Business Name): KEN SAMITH OERDING N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KEN SAMITH VORN

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32605 TEMECULA PKWY STE 220
TEMECULA CA
92592-6839
US

IV. Provider business mailing address

32605 TEMECULA PKWY
TEMECULA CA
92592-6837
US

V. Phone/Fax

Practice location:
  • Phone: 855-940-4867
  • Fax:
Mailing address:
  • Phone: 855-940-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95006294
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95006294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: