Provider Demographics
NPI:1952331035
Name:KENNETH C. LOW MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KENNETH C. LOW MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-794-0660
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046700Medicaid
CAF16583Medicare UPIN
CAA45959Medicare UPIN
CAF43732Medicare UPIN
CAZZZ25612ZMedicare ID - Type Unspecified