Provider Demographics
NPI:1982629192
Name:KRANTZ, KENNETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:KRANTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3401 S HARBOR BLVD
Mailing Address - Street 2:DEPT. OF OPHTHALMOLOGY
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7933
Mailing Address - Country:US
Mailing Address - Phone:888-988-2800
Mailing Address - Fax:
Practice Address - Street 1:3401 S HARBOR BLVD
Practice Address - Street 2:DEPT. OF OPHTHALMOLOGY
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7933
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:714-427-7851
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90159207W00000X
CAA94774207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH89535Medicare UPIN