Grudko, Kenneth
Grudko, Kenneth is an individual health care provider with primary practice located at 10666 N Torrey Pines Rd , La Jolla CA 92037-1027. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pulmonary Disease, which is considered as his primary health care specialty. Grudko, Kenneth can be contacted via phone (858) 554-8860.Contact Information
Primary practice address
10666 N Torrey Pines Rd
La Jolla CA 92037-1027
Phone: (858) 554-8860
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | G80633 | California |
Profile Details
| NPI number | 1164522199 |
|---|---|
| LBN Legal business name | Grudko, Kenneth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 22nd, 2006 |
| Last updated | Jun 25th, 2009 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164522199 | NPPES |
| California | MEDICAID | 00G806330 |
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