Healthcare Provider Details

I. General information

NPI: 1407348196
Provider Name (Legal Business Name): KENWOOD OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 COLEMANS RUN
CONVERSE TX
78109-3834
US

IV. Provider business mailing address

3821 COLEMANS RUN
CONVERSE TX
78109-3834
US

V. Phone/Fax

Practice location:
  • Phone: 210-665-2544
  • Fax:
Mailing address:
  • Phone: 210-665-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID D WILLIAMS
Title or Position: OWNER / PRESIDENT & CEO
Credential: PHD, MPH, MBA, CNIM
Phone: 210-665-2544