Provider Demographics
NPI:1396084752
Name:FAUBEL, KENNETH (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:FAUBEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNITED STATES COAST GUARD MEDICAL CLINIC
Mailing Address - Street 2:1001 S. SEASIDE AVE., BLDG 23
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731
Mailing Address - Country:US
Mailing Address - Phone:310-521-6060
Mailing Address - Fax:
Practice Address - Street 1:UNITED STATES COAST GUARD MEDICAL CLINIC
Practice Address - Street 2:1001 S. SEASIDE AVE., BLDG 23
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731
Practice Address - Country:US
Practice Address - Phone:310-521-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203951207Q00000X
390200000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program