Provider Demographics
NPI:1306959598
Name:HEAD, KENNETH PAUL (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:HEAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1818 VERDUGO BLVD
Mailing Address - Street 2:201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1403
Mailing Address - Country:US
Mailing Address - Phone:818-952-2712
Mailing Address - Fax:818-952-4152
Practice Address - Street 1:1818 VERDUGO BLVD
Practice Address - Street 2:201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1403
Practice Address - Country:US
Practice Address - Phone:818-952-2712
Practice Address - Fax:818-952-4152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA21582207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22671Medicare UPIN