Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G23234 | CA |
NPI | 1043417447 |
---|---|
Provider Name | Dr. Charles D Kenyon |
First Address | Huntington Beach, CA 92649-4219 |
Second Address | Anaheim, CA 92807-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |