Healthcare Provider Details

I. General information

NPI: 1417900309
Provider Name (Legal Business Name): KENNETH E BREEDEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 GOETHALS DR
RICHLAND WA
99352-3527
US

IV. Provider business mailing address

6703 W RIO GRANDE AVE
KENNEWICK WA
99336-2623
US

V. Phone/Fax

Practice location:
  • Phone: 509-460-5588
  • Fax: 509-783-5438
Mailing address:
  • Phone: 509-460-5588
  • Fax: 509-783-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00010299
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOP00001987
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP00001987
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOP00001987
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOP00001987
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001987
License Number StateWA
# 7
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOP00001987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: