Individual
KENNETH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1145 STURGIS STREET, TWENTYNINE PALMS, CA 92278
(410) 707-6293
Mailing address
1145 STURGIS STREET, TWENTYNINE PALMS, CA 92277
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A203427
CA
208D00000X
General Practice Physician
0101275874
VA
Other
Enumeration date
04/29/2021
Last updated
12/15/2025
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