Individual
DR. LOUIS KENNETH COUNTRYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
375 HUNTINGTON DR, # D, SAN MARINO, CA 91108-2357
(626) 287-9611
(626) 799-2904
Mailing address
375 HUNTINGTON DR, # D, SAN MARINO, CA 91108-2357
(626) 287-9611
(626) 799-2904
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G5963
CA
Other
Enumeration date
10/12/2005
Last updated
07/08/2007
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