Provider Demographics
NPI:1932198108
Name:HOLT, KENNETH MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MURRAY
Last Name:HOLT
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 1:23451 MADISON ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4737
Mailing Address - Country:US
Mailing Address - Phone:310-375-1246
Mailing Address - Fax:310-375-0590
Practice Address - Street 1:23451 MADISON ST STE 290
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4737
Practice Address - Country:US
Practice Address - Phone:310-375-1246
Practice Address - Fax:310-375-0590
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49530207RG0100X
CAG049530207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10954650OtherCAQH
I4023572OtherAETNA