Provider Demographics
NPI:1588607766
Name:REHM, KENNETH B (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:REHM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1553 GRAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2427
Mailing Address - Country:US
Mailing Address - Phone:760-744-6226
Mailing Address - Fax:760-744-6277
Practice Address - Street 1:1553 GRAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2427
Practice Address - Country:US
Practice Address - Phone:760-744-6226
Practice Address - Fax:760-744-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE2808213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28081Medicaid
CA000E28080Medicaid
CAE2808Medicare PIN
CA000E28080Medicaid
CA000E28081Medicaid
CAE2808DMedicare PIN