Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 11969 | CA |
N | 207R00000X | Internist | 11969 | CA |
N | 111NI0900X | Internist | 11969 | CA |
N | 111NN1001X | Nutrition | 11969 | CA |
N | 111NR0400X | Rehabilitation Chiropractor | 11969 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 11969 | CA |
NPI | 1558583591 |
---|---|
Provider Name | Dr. Kenneth Wolfgang Luther |
First Address | El Segundo, CA 90245-2006 |
Second Address | Los Angeles, CA 90066-1408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 17/05/2011 |