Provider Demographics
NPI:1003980822
Name:WEN, KENNETH C (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:WEN
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 1:3080 BRISTOL ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3093
Mailing Address - Country:US
Mailing Address - Phone:714-445-0220
Mailing Address - Fax:714-445-0246
Practice Address - Street 1:3080 BRISTOL ST
Practice Address - Street 2:SUITE 600
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3093
Practice Address - Country:US
Practice Address - Phone:714-445-0220
Practice Address - Fax:714-445-0246
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231432207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease