Individual
KENNETH L. ANDERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1945 GARNET AVE, SAN DIEGO, CA 92109-3595
(858) 224-7977
(858) 224-7978
Mailing address
1945 GARNET AVENUE, SAN DIEGO, CA 92109-4292
(858) 224-7977
(858) 224-7978
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
20A5441
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F01223
UPIN
CA
Enumeration date
07/26/2006
Last updated
11/03/2011
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