Individual
DR. KENNETH L. RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
525 SOUTH DR, SUITE 207, MOUNTAIN VIEW, CA 94040-4213
(650) 988-0900
(650) 948-1837
Mailing address
525 SOUTH DR, SUITE 207, MOUNTAIN VIEW, CA 94040-4213
(650) 988-0900
(650) 948-1837
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY19767
CA
103TC0700X
Clinical Psychologist
PSY19767
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
109582
DIVISION OF WORKERS COMPENSATION-QME
CA
01
—
51043
NATIONAL REGISTER OF HEALTH CARE PSYCHOLOGISTS
CA
Enumeration date
05/27/2005
Last updated
02/03/2013
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