Healthcare Provider Details

I. General information

NPI: 1427179969
Provider Name (Legal Business Name): KENNETH L SAUL MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAALAND DRIVE #104
THOUSAND OAKS CA
91361-3003
US

IV. Provider business mailing address

425 HAALAND DRIVE #104
THOUSAND OAKS CA
91361-3003
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-1948
  • Fax: 805-494-1947
Mailing address:
  • Phone: 805-494-1948
  • Fax: 805-494-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG43044
License Number StateCA

VIII. Authorized Official

Name: KENNETH L SAUL
Title or Position: OWNER
Credential: M.D.
Phone: 805-494-1948