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General NPI Number Information
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NPI Number | 1518829340
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Entity Type | Individual
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Provider Name | KEN CHRISTOPH MANU
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Gender | Male
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1020 W MAIN ST
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City | MERCED
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State | CA
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Zip | 95340-4521
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Country | US
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Telephone | 978-746-4373
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 GORDON HAMMOND PL
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City | MANTECA
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State | CA
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Zip | 95337-7029
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Country | US
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Telephone | 978-746-4373
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Fax | 978-746-4373
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 225400000X
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License Number State | CA
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