Provider Demographics
NPI:1760480420
Name:JONES, KENNETH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1774
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-1774
Mailing Address - Country:US
Mailing Address - Phone:509-667-2535
Mailing Address - Fax:509-667-2595
Practice Address - Street 1:526 N CHELAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6696
Practice Address - Country:US
Practice Address - Phone:509-667-2535
Practice Address - Fax:509-667-2595
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA028268208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD16689Medicare UPIN