Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A72098 | CA |
NPI | 1396823092 |
---|---|
Provider Name | Dr. Kenneth W. Lien |
First Address | Castro Valley, CA 94546-5316 |
Second Address | Castro Valley, CA 94546-5316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 03/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396823092 | (05) | CA |
CA110780 | GRP PTAN FOR ALLERGY, ASTHMA & SINUS CENTERS OF SILICON VALLEY (01) | CA |
EK627Z | INDIVIDUAL MEDICARE PTAN (01) | CA |