Individual
KENNETH GLEN WYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
47111 MONROE ST, INDIO, CA 92201-6739
(760) 347-6191
(760) 775-8017
Mailing address
47111 MONROE ST, INDIO, CA 92201-6739
(760) 347-6191
(760) 775-8017
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
A64344
CA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
A64344
CA
Other
Enumeration date
08/16/2006
Last updated
01/28/2020
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