Provider Demographics
NPI:1144891458
Name:LUNA, KENNETH CHRISTIAN (DNP, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:KENNETH CHRISTIAN
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, AGACNP-BC
Mailing Address - Street 1:820 S TRAILBLAZER CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4881
Mailing Address - Country:US
Mailing Address - Phone:714-606-6821
Mailing Address - Fax:
Practice Address - Street 1:820 S TRAILBLAZER CIR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4881
Practice Address - Country:US
Practice Address - Phone:714-606-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner