| Kenneth K. Wogensen, Md. Inc | |
|
1015 North First Avenue Suite A Arcadia CA 91006-2534 | |
| (626) 566-2866 | |
| (626) 566-2850 |
| Full Name | Kenneth K. Wogensen, Md. Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1015 North First Avenue, Arcadia, California |
| Authorized Official Name and Position | Kenneth K Wogensen (PRESIDENT) |
| Authorized Official Contact | 6265662866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth K. Wogensen, Md. Inc 1015 North First Avenue Suite A Arcadia CA 91006-2534 Ph: (626) 566-2866 | Kenneth K. Wogensen, Md. Inc 1015 North First Avenue Suite A Arcadia CA 91006-2534 Ph: (626) 566-2866 |
| NPI Number | 1649249616 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 03/07/2023 |
| Certification Date | 01/09/2023 |
| Medicare PECOS PAC ID | 5496789539 |
|---|---|
| Medicare Enrollment ID | O20050919000923 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649249616 | NPI | - | NPPES |
| G52870 | Other | CA | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | G52870 (California) | Primary |
| Provider Name | Kenneth Wogensen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1932109295 PECOS PAC ID: 8921032061 Enrollment ID: I20050920000505 |
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