Healthcare Provider Details

I. General information

NPI: 1770670127
Provider Name (Legal Business Name): KENNETH W WRIGHT M D A PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 TORRANCE BLVD STE B
TORRANCE CA
90501-0401
US

IV. Provider business mailing address

2410 TORRANCE BLVD STE B
TORRANCE CA
90501-0401
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-6420
  • Fax: 310-946-0363
Mailing address:
  • Phone: 310-652-6420
  • Fax: 310-946-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG37700
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH W WRIGHT
Title or Position: PRESIDENT
Credential: MD
Phone: 310-652-6420