Individual
KENNETH O SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8383 WILSHIRE BLVD, SUITE 440, BEVERLY HILLS, CA 90211-2425
(323) 655-8036
(323) 655-8443
Mailing address
8383 WILSHIRE BLVD STE 440, BEVERLY HILLS, CA 90211-2436
(323) 655-8036
(323) 655-8443
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G39756
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G397560
—
CA
Enumeration date
07/11/2006
Last updated
06/18/2020
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