Provider Demographics
NPI:1083031504
Name:KENWORTHEY, WILLIAM (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KENWORTHEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:905 MAPLE STREET
Mailing Address - Street 2:3RD FLOOR, NEUROSURGERY CLINIC, OFFICE #3095
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-299-2290
Mailing Address - Fax:650-299-2677
Practice Address - Street 1:905 MAPLE STREET
Practice Address - Street 2:3RD FLOOR, NEUROSURGERY CLINIC, OFFICE #3095
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063
Practice Address - Country:US
Practice Address - Phone:650-299-2290
Practice Address - Fax:650-299-2677
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2022-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA51396363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical