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General NPI Number Information
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NPI Number | 1568631901
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Entity Type | Organization
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Legal Business Name | KENNETH TYE, M.D., INC.
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Dates
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Enumeration Date | 02/28/2008
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 1250 S SUNSET AVE #202
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City | WEST COVINA
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State | CA
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Zip | 91790-3961
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Country | US
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Telephone | 626-960-6588
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Fax | 626-338-0688
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Provider Business Mailing Address
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Address Line | 1250 S SUNSET AVE #202
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City | WEST COVINA
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State | CA
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Zip | 91790-3961
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Country | US
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Telephone | 626-960-6588
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Fax | 626-338-0688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH TYE
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Credential | M.D.
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Telephone | 626-960-6588
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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 | A32035
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License Number State | CA
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