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General NPI Number Information
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NPI Number | 1013021708
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Entity Type | Individual
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Provider Name | WILLIAM KENNETH HALLIDAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 2444 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-2306
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Country | US
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Telephone | 323-201-4130
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Fax | 323-201-4134
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Provider Business Mailing Address
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Address Line | 12900 PARK PLAZA DR STE 150
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City | CERRITOS
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State | CA
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Zip | 90703-9329
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Country | US
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Telephone | 562-977-4674
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Fax | 562-741-4479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A23526
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License Number State | CA
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