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General NPI Number Information
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NPI Number | 1659164275
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Entity Type | Individual
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Provider Name | KENNETH BERNARD BROWN-UNDERWOOD III
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 12/21/2025
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Provider Practice Location Address
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Address Line | 1333 WILLOW PASS RD STE 200
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City | CONCORD
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State | CA
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Zip | 94520-7923
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Country | US
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Telephone | 925-338-7928
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Fax |
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Provider Business Mailing Address
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Address Line | 2032 E 30TH ST APT 123
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City | OAKLAND
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State | CA
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Zip | 94606-3448
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Country | US
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Telephone | 619-865-4870
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Fax |
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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