Provider Demographics
NPI:1649204017
Name:LOW, KENNETH C (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:LOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38707 STIVERS ST
Mailing Address - Street 2:#B
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5337
Mailing Address - Country:US
Mailing Address - Phone:510-794-0660
Mailing Address - Fax:510-793-5044
Practice Address - Street 1:38707 STIVERS ST
Practice Address - Street 2:#B
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5337
Practice Address - Country:US
Practice Address - Phone:510-794-0660
Practice Address - Fax:510-793-5044
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046700Medicaid
CAZZZ25612ZMedicare ID - Type Unspecified
CAA45959Medicare UPIN