Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E2796 | CA |
NPI | 1295767002 |
---|---|
Provider Name | Kenneth W. Vogen |
First Address | Laguna Woods, CA 92637-3167 |
Second Address | Laguna Woods, CA 92637-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 14/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E2796 | STATE LICENSE (01) | CA |
P00179590 | RAILROAD MEDI-CARE PIN (01) | CA |
T11470 | (02) | CA |