Provider Demographics
NPI:1447911912
Name:MAYFIELD, KENNETH II (BS)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:MAYFIELD
Suffix:II
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6737 DENNY AVE APT 36
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-2296
Mailing Address - Country:US
Mailing Address - Phone:310-498-0167
Mailing Address - Fax:
Practice Address - Street 1:6737 DENNY AVE APT 36
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-2296
Practice Address - Country:US
Practice Address - Phone:310-498-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist