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General NPI Number Information
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NPI Number | 1104302157
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Entity Type | Organization
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Legal Business Name | KENNETH STEPHAN BROWN MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 1415 ROSS AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-4306
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Country | US
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Telephone | 760-339-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1000
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Fax | 714-647-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH BROWN
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Credential | MD
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Telephone | 714-347-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G70912
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License Number State | CA
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