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General NPI Number Information
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NPI Number | 1669577128
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Entity Type | Individual
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Provider Name | KENNETH B. PIERCE D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 305 CAZADOR LN APT C
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-6642
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Country | US
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Telephone | 808-652-6060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1341
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City | SAN CLEMENTE
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State | CA
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Zip | 92674-1341
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Country | US
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Telephone | 808-652-6060
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Fax | 888-323-0575
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DOS-754
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License Number State | HI
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