Wallis, Kenneth C

Wallis, Kenneth C is an individual health care provider with primary practice located at 1260 Lake Blvd Suite #214, Davis CA 95616-2614. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Wallis, Kenneth C can be contacted via phone (530) 771-2308.

Contact Information

Primary practice address
1260 Lake Blvd Suite #214 Davis CA 95616-2614
Phone: (530) 771-2308
Fax: (530) 771-2309
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X C-41960 California
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 811674181205 Utah

Profile Details

NPI number 1649243692
LBN Legal business name Wallis, Kenneth C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Jul 9th, 2021 - about 4 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 1649243692 NPPES
Utah Other 107005564101 INTRMTN. HEALTH CARE
Utah Other 261795 INTRMTN. HEALTH CARE
Utah Other 942938348WA1 INTRMTN. HEALTH CARE

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