Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 030774 | CA |
NPI | 1366450413 |
---|---|
Provider Name | Dr. Kenneth Allen Storum |
First Address | San Diego, CA 92108 |
Second Address | San Diego, CA 92108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 08/07/2007 |