Provider Demographics
NPI:1174541288
Name:WILLIAMS, KENNETH LLOYD JR (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LLOYD
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:15785 LAGUNA CANYON RD.
Mailing Address - Street 2:SUITE 390
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-333-2999
Mailing Address - Fax:949-387-2002
Practice Address - Street 1:15785 LAGUNA CANYON RD.
Practice Address - Street 2:SUITE 390
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-333-2999
Practice Address - Fax:949-387-2002
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-01-18
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Provider Licenses
StateLicense IDTaxonomies
CA20A5021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93607Medicare UPIN