Provider Demographics
NPI:1245472257
Name:GREY, KEN K (DOM)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:K
Last Name:GREY
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S US HIGHWAY 1 STE 203-242
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-1198
Mailing Address - Country:US
Mailing Address - Phone:561-746-7300
Mailing Address - Fax:
Practice Address - Street 1:1025 MILITARY TRL
Practice Address - Street 2:SUITE 113
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7040
Practice Address - Country:US
Practice Address - Phone:561-354-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist