Gordon, Richard Kenneth

Gordon, Richard Kenneth is an sole proprietor health care provider with primary practice located at 8700 Reseda Blvd Suite 204, Northridge CA 91324-4041. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Gordon, Richard Kenneth can be contacted via phone (818) 772-7090.

Contact Information

Primary practice address
8700 Reseda Blvd Suite 204 Northridge CA 91324-4041
Phone: (818) 772-7090
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X G56286 California

Profile Details

NPI number 1144242645
LBN Legal business name Gordon, Richard Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 24th, 2006
Last updated Jan 13th, 2011 - about 13 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 1144242645 NPPES
California MEDICAID 00G562860

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