Provider Demographics
NPI:1255753075
Name:KENNETH STARR MD INC
Entity type:Organization
Organization Name:KENNETH STARR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-797-9977
Mailing Address - Street 1:295 MAR VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 VAN BEURDEN DR
Practice Address - Street 2:STE 103
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3380
Practice Address - Country:US
Practice Address - Phone:626-797-9977
Practice Address - Fax:929-737-8705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health