Provider Demographics
NPI:1003999285
Name:KENNETH K PADDIE A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:KENNETH K PADDIE A PROFESSIONAL CORP
Other - Org Name:ORANGE COAST SINUS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:PADDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-2555
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-364-2555
Mailing Address - Fax:949-364-0280
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 261
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-2555
Practice Address - Fax:949-364-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24266207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23885Medicare UPIN
CAA24266Medicare PIN