Provider Demographics
NPI:1922101963
Name:DUCKER, KEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:
Last Name:DUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20126 STANTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5270
Mailing Address - Country:US
Mailing Address - Phone:510-881-4210
Mailing Address - Fax:510-881-4213
Practice Address - Street 1:20126 STANTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5270
Practice Address - Country:US
Practice Address - Phone:510-881-4210
Practice Address - Fax:510-881-4213
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44312Medicare UPIN