Provider Demographics
NPI:1528075751
Name:ELMAN, KENNETH DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DONALD
Last Name:ELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:29525 CANWOOD ST
Mailing Address - Street 2:#305
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4233
Mailing Address - Country:US
Mailing Address - Phone:818-707-7789
Mailing Address - Fax:818-707-7797
Practice Address - Street 1:29525 CANWOOD ST
Practice Address - Street 2:#305
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4233
Practice Address - Country:US
Practice Address - Phone:818-707-7789
Practice Address - Fax:818-707-7797
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG72087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB227753OtherGROUP PTAN
CACB227752OtherPTAN
CA1952318461OtherGROUP NPI
CA1528075751OtherNPI INDIVIDUAL
CACB227752OtherPTAN