Provider Demographics
NPI:1255347035
Name:ECONOMY, KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ECONOMY
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 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:6880 PALM AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4270
Practice Address - Country:US
Practice Address - Phone:707-823-7628
Practice Address - Fax:707-823-1521
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32010207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01731276OtherRR PTAN
CA00G320100Medicaid
A44956Medicare UPIN
CACA160551Medicare PIN
CACA160552Medicare PIN
CACA113893Medicare PIN
CAP01731276OtherRR PTAN
CA00G320100Medicaid
CA00G320100Medicare PIN
CACA160550Medicare PIN
CAGY225AMedicare PIN