Provider Demographics
NPI:1396819983
Name:YORK, KENNETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
Last Name:YORK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:210 S GRAND AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4205
Mailing Address - Country:US
Mailing Address - Phone:626-335-0266
Mailing Address - Fax:626-914-6508
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4205
Practice Address - Country:US
Practice Address - Phone:626-335-0266
Practice Address - Fax:626-914-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG44757207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49741Medicare UPIN
CAG44757Medicare ID - Type Unspecified