Provider Demographics
NPI:1659164275
Name:BROWN-UNDERWOOD, KENNETH BERNARD III
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:BERNARD
Last Name:BROWN-UNDERWOOD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 E 30TH ST APT 123
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-3448
Mailing Address - Country:US
Mailing Address - Phone:619-865-4870
Mailing Address - Fax:
Practice Address - Street 1:1333 WILLOW PASS RD STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7923
Practice Address - Country:US
Practice Address - Phone:925-338-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist