# KENNETH C NIEBERG MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396863080
- **Authorized official:** KENNETH C NIEBERG M.D. (PRESIDENT)
- **Authorized official phone:** (323) 267-0477

## Contact information

- **Practice address:** 13222 BLOOMFIELD AVE, DEPARTMENT OF PATHOLOGY, NORWALK, CA 90650-3249
- **Practice address phone:** (323) 462-2271
- **Mailing address:** PO BOX 10076, VAN NUYS, CA 91410-0076
- **Mailing address phone:** (805) 578-8300
- **Mailing address fax:** (805) 578-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZC0500X | Cytopathology Physician | — | NULL | — |
| 207ZC0500X | Cytopathology Physician | — | — | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2007
- **Last updated:** 06/01/2010