Provider Demographics
NPI:1023566924
Name:MCCALL, KENNETH C JR (ATC, CSCS, EMT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:C
Last Name:MCCALL
Suffix:JR
Gender:M
Credentials:ATC, CSCS, EMT
Other - Prefix:
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Mailing Address - Street 1:789 WILDCAT WAY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-7402
Mailing Address - Country:US
Mailing Address - Phone:714-990-7850
Mailing Address - Fax:
Practice Address - Street 1:789 WILDCAT WAY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-7402
Practice Address - Country:US
Practice Address - Phone:714-990-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer