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General NPI Number Information
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NPI Number | 1679519649
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Entity Type | Individual
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Provider Name | KENNETH J WILKENS MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 17360 BROOKHURST ST.
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 877-844-0012
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Fax | 714-665-4680
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Provider Business Mailing Address
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Address Line | 17360 BROOKHURST ST. ATTN: ADMINISTRATION
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 877-844-0012
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Fax | 714-665-4680
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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 | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | A80116
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License Number State | CA
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