Provider Demographics
NPI:1285697342
Name:HUFF, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21840 NORMANDIE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5189
Mailing Address - Fax:310-781-9352
Practice Address - Street 1:21840 NORMANDIE AVE STE 700
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5189
Practice Address - Fax:310-328-1415
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG508742084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G508740Medicaid
CAA93017Medicare UPIN
CA00G508740Medicaid
CAWG50874DMedicare ID - Type UnspecifiedPPIN