1407155641 NPI number — MR. WILLIAM MICHAEL KERNOZEK II

Table of content: MR. WILLIAM MICHAEL KERNOZEK II (NPI 1407155641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407155641 NPI number — MR. WILLIAM MICHAEL KERNOZEK II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERNOZEK
Provider First Name:
WILLIAM
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
II
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407155641
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15422 FLORWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWNDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90260-3535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-844-3912
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4408 CLEARWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89436-6363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-229-6826
Provider Business Practice Location Address Fax Number:
775-622-4837
Provider Enumeration Date:
03/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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