Provider Demographics
NPI:1467452268
Name:CONRAD, JOHN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNETH
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23025 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1629
Mailing Address - Country:US
Mailing Address - Phone:818-558-7700
Mailing Address - Fax:
Practice Address - Street 1:2950 W BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2309
Practice Address - Country:US
Practice Address - Phone:818-842-4400
Practice Address - Fax:818-842-4401
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ315362086S0129X
CAA745742086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H58485Medicare UPIN