Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 231432 | NY |
NPI | 1003980822 |
---|---|
Provider Name | Kenneth C Wen |
First Address | Costa Mesa, CA 92626-3093 |
Second Address | Costa Mesa, CA 92626-3093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 14/02/2020 |