Provider Demographics
NPI:1730227133
Name:OWYANG, KENNETH M (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:M
Last Name:OWYANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1707
Mailing Address - Country:US
Mailing Address - Phone:650-326-0590
Mailing Address - Fax:
Practice Address - Street 1:442 RAMONA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1707
Practice Address - Country:US
Practice Address - Phone:650-326-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6528 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist