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NPI Code Detail

MEDICARE: KENNETH H MULLEN MD

MEDICARE: KENNETH H MULLEN MD
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
1207Q00000XFamily Medicine PhysicianG27186CA

General Provider Information

NPI Number : 1922065721
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH H MULLEN MD
Provider Business Mailing Address
First Line : PO BOX 241011
Second Line :
City : LODI
State : CA
Zip : 95241-9511
Country : US
Telephone Number : 209-339-7435
Fax Number : 209-339-7858
Provider Business Practice Location Address
First Line : 1901 W KETTLEMAN LN
Second Line : # 200
City : LODI
State : CA
Zip : 95242-4337
Country : US
Telephone Number : 209-334-8540
Fax Number : 209-368-2885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 02/14/2012

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Directions to “ KENNETH H MULLEN MD” Practice Location

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