Individual
DR. KENNETH GRUDKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10666 N TORREY PINES RD, LA JOLLA, CA 92037-1027
(858) 554-8860
Mailing address
54433 FILE, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G80633
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G806330
—
CA
Enumeration date
09/22/2006
Last updated
06/25/2009
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