Individual
KENNETH P. LYONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20162 SW BIRCH ST, SUITE 150, NEWPORT BEACH, CA 92660-0787
(949) 221-1700
(949) 221-1704
Mailing address
20162 SW BIRCH ST, SUITE 150, NEWPORT BEACH, CA 92660-0787
(949) 221-1700
(949) 221-1704
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
G12843
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G128430
BLUE SHIELD
CA
05
—
00G128430
—
CA
Enumeration date
06/08/2006
Last updated
07/08/2007
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