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Organization
KENNETH C NIEBERG MD INC
Active
Organization
KENNETH C NIEBERG MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH C NIEBERG MD (PRESIDENT)
(323) 462-2271
Entity
Organization
Contact information
Practice address
6245 DE LONGPRE AVE, HOLLYWOOD, CA 90028-8253
(323) 462-2271
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
—
NULL
207ZC0500X
Cytopathology Physician
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
03/29/2006
Last updated
06/01/2010
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