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General NPI Number Information
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NPI Number | 1902961444
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Entity Type | Organization
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Legal Business Name | KENNETH P. TWAY, M.D., F.A.C.C., INC.
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1106 PACIFIC ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3302
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Country | US
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Telephone | 805-546-9500
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Fax | 805-546-9699
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Provider Business Mailing Address
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Address Line | 1106 PACIFIC ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3302
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Country | US
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Telephone | 805-546-9500
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Fax | 805-546-9699
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH PAUL TWAY
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Credential | M.D.
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Telephone | 805-546-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | G39105
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G39106
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License Number State | CA
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