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NPI Code Detail

MEDICARE: DR. KENNETH BALLAN M.D.

MEDICARE: DR. KENNETH BALLAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianG29221CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134123474
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH BALLAN M.D.
Provider Business Mailing Address
First Line : 777 FLOWER ST
Second Line : STE A
City : GLENDALE
State : CA
Zip : 91201-3000
Country : US
Telephone Number : 818-637-2000
Fax Number : 818-242-8761
Provider Business Practice Location Address
First Line : 191 S BUENA VISTA ST
Second Line : STE. 215
City : BURBANK
State : CA
Zip : 91505-4554
Country : US
Telephone Number : 818-295-6944
Fax Number : 818-295-6948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 04/14/2011

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