Provider Demographics
NPI:1831194992
Name:SON, KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:SON
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 1:201 N RIVERSIDE AVE STE D3
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5470
Mailing Address - Country:US
Mailing Address - Phone:810-637-8736
Mailing Address - Fax:810-329-8970
Practice Address - Street 1:4100 RIVER RD
Practice Address - Street 2:ACUTE CARE DEPT.
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054
Practice Address - Country:US
Practice Address - Phone:810-329-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004799152W00000X
MI4301100071208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No152W00000XEye and Vision Services ProvidersOptometrist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist