Provider Demographics
NPI:1639175672
Name:KRONE, KENNETH DALE (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DALE
Last Name:KRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2605
Mailing Address - Street 2:
Mailing Address - City:AVILA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93424-2605
Mailing Address - Country:US
Mailing Address - Phone:805-627-1713
Mailing Address - Fax:888-691-8259
Practice Address - Street 1:2845 ROCK WREN LN
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3536
Practice Address - Country:US
Practice Address - Phone:805-627-1713
Practice Address - Fax:888-691-8259
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG239882085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G239880Medicaid
CAA42120Medicare UPIN
CA00G239880Medicaid