Provider Demographics
NPI:1639189434
Name:ARENSON, KENNETH J (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:ARENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE #410
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-340-5600
Mailing Address - Fax:818-340-5650
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #410
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-340-5600
Practice Address - Fax:818-340-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A288450207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4371616Medicaid
A83864Medicare UPIN
CA4371616Medicaid