Provider Demographics
NPI:1871616516
Name:MORA, WILLIAM KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:MORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3301 ALTA ARDEN EXPY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2121
Mailing Address - Country:US
Mailing Address - Phone:916-489-4400
Mailing Address - Fax:916-489-1710
Practice Address - Street 1:3301 ALTA ARDEN EXPY
Practice Address - Street 2:SUITE 3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-489-4400
Practice Address - Fax:916-489-1710
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG58515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE69107Medicare UPIN
CA00G585152Medicare ID - Type Unspecified