Provider Demographics
NPI:1366186777
Name:VALENTIN, KENNETH MICAHEL
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:MICAHEL
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:M
Other - Last Name:VALENTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1912 UNIVERSITY BUSINESS DR STE 407
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5804
Mailing Address - Country:US
Mailing Address - Phone:214-859-0983
Mailing Address - Fax:
Practice Address - Street 1:1912 UNIVERSITY BUSINESS DR STE 407
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5804
Practice Address - Country:US
Practice Address - Phone:214-859-0983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor