Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A106366 | CA |
NPI | 1023347846 |
---|---|
Provider Name | Dr. Kenneth L Chambers |
First Address | Fountain Valley, CA 92708-4055 |
Second Address | Fountain Valley, CA 92708-4055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A106366 | MEDICAL LICENSE (01) | CA |