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General NPI Number Information
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NPI Number | 1760334312
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Entity Type | Organization
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Legal Business Name | KENNETH CARL RUSS MD INC
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 36917 COOK ST STE 103
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City | PALM DESERT
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State | CA
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Zip | 92211-6072
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Country | US
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Telephone | 760-835-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HOLLAND STE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH C RUSS
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Credential | MD
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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