Provider Demographics
NPI:1356667521
Name:HOUSE, KENNETH M (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:HOUSE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10444 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6959
Mailing Address - Country:US
Mailing Address - Phone:310-475-1670
Mailing Address - Fax:310-457-5649
Practice Address - Street 1:10444 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6959
Practice Address - Country:US
Practice Address - Phone:310-475-1670
Practice Address - Fax:310-457-5649
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG142042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry