Provider Demographics
NPI:1003817537
Name:BROWN, KENNETH SPIERS (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:SPIERS
Last Name:BROWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1866 N ORANGE GROVE AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3031
Mailing Address - Country:US
Mailing Address - Phone:909-620-4373
Mailing Address - Fax:909-620-7179
Practice Address - Street 1:1866 N ORANGE GROVE AVE
Practice Address - Street 2:STE 102
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3031
Practice Address - Country:US
Practice Address - Phone:909-620-4373
Practice Address - Fax:909-620-7179
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG304546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G304560Medicaid
AB6616001OtherDEA
AB6616001OtherDEA
A44429Medicare UPIN