MEDICARE: DR. KENNETH D MURRAY 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
1	207Q00000X	Family Medicine Physician	G50230	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1720029481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH D MURRAY M.D.

Provider Business Mailing Address
First Line	:	777 FLOWER ST
Second Line	:	SUITE A
City	:	GLENDALE
State	:	CA
Zip	:	91201-3015
Country	:	US
Telephone Number	:	818-637-2000
Fax Number	:	818-242-8761

Provider Business Practice Location Address
First Line	:	2061 W ALAMEDA AVE
Second Line	:	SUITE 111
City	:	BURBANK
State	:	CA
Zip	:	91506-2932
Country	:	US
Telephone Number	:	818-295-5920
Fax Number	:	818-295-6965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	09/21/2007

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