Provider Demographics
NPI:1609989201
Name:WILKINS, KENNETH (DPM)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3628
Mailing Address - Country:US
Mailing Address - Phone:323-357-6683
Mailing Address - Fax:
Practice Address - Street 1:10300 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002
Practice Address - Country:US
Practice Address - Phone:323-357-6683
Practice Address - Fax:232-291-3081
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1069213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E1069Medicaid
E1069Medicare ID - Type Unspecified
CA000E1069Medicaid
CA0556880001Medicare NSC