Diddie, Kenneth Robert

Diddie, Kenneth Robert is an sole proprietor health care provider with primary practice located at 1220 La Venta Dr Suite 211, Westlake Village CA 91361-3703. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Diddie, Kenneth Robert can be contacted via phone (805) 379-0200.

Contact Information

Primary practice address
1220 La Venta Dr Suite 211 Westlake Village CA 91361-3703
Phone: (805) 379-0200
Fax: (805) 496-5204
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X G033939 California

Profile Details

NPI number 1184684219
LBN Legal business name Diddie, Kenneth Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 24th, 2006
Last updated Mar 1st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184684219 NPPES
California MEDICAID 00G339391

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