Provider Demographics
NPI:1225231137
Name:THOMPSON, KENNITH O (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:KENNITH
Middle Name:O
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:7957 PAINTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2434
Mailing Address - Country:US
Mailing Address - Phone:562-945-1396
Mailing Address - Fax:562-945-0331
Practice Address - Street 1:7957 PAINTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2434
Practice Address - Country:US
Practice Address - Phone:562-945-1396
Practice Address - Fax:562-945-0331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG41918208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery