Provider Demographics
NPI:1003809963
Name:REXINGER, KENNETH LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:LLOYD
Last Name:REXINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 VIA SUERTE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6531
Mailing Address - Country:US
Mailing Address - Phone:949-364-5600
Mailing Address - Fax:949-364-2231
Practice Address - Street 1:831 VIA SUERTE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6531
Practice Address - Country:US
Practice Address - Phone:949-364-5600
Practice Address - Fax:949-364-2231
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEM213ZMedicare PIN
CAEM213YMedicare PIN
CAF30634Medicare UPIN
CAWG69073AMedicare PIN