Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 57040 | GA |
NPI | 1790921294 |
---|---|
Provider Name | Dr. Kenneth William Anderson |
First Address | Beverly Hills, CA 90211-2227 |
Second Address | Beverly Hills, CA 90211-2227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 05/01/2009 |