Provider Demographics
NPI:1114417862
Name:ASHOURI, KENAN B (MD)
Entity type:Individual
Prefix:DR
First Name:KENAN
Middle Name:B
Last Name:ASHOURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7960
Mailing Address - Country:US
Mailing Address - Phone:561-734-2746
Mailing Address - Fax:561-734-2746
Practice Address - Street 1:2800 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7960
Practice Address - Country:US
Practice Address - Phone:561-734-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-51079208800000X
FLME168171208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology