Provider Demographics
NPI:1306379359
Name:OERDING, KEN SAMITH (NP)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:SAMITH
Last Name:OERDING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KEN
Other - Middle Name:SAMITH
Other - Last Name:VORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5422 RESERVOIR DRIVE
Mailing Address - Street 2:E7
Mailing Address - City:SAN DIEGO CA
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-804-0236
Mailing Address - Fax:
Practice Address - Street 1:36892 CAPRICIOUS LN
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2794
Practice Address - Country:US
Practice Address - Phone:619-804-0236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily