Kenneth Brian Waltzer, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

A45950 Issued in CA

Practice address

171 Pier Ave # 160
Santa Monica, CA 90405-5311

Phone

(424) 228-2421

NPI assigned

Mar 15, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331769600000",
    "number": "1437424090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 PIER AVE # 160",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904055311",
            "telephone_number": "424-228-2421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 PIER AVE # 160",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904055311",
            "telephone_number": "424-228-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTZER",
        "first_name": "KENNETH",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-03-15",
        "last_updated": "2012-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A45950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Walsdorf, LMFT
• Therese Anne Walsh, L.AC., PH.D.
• Walter K Theis MD a Medical Corporation
• Anique Walters, DPT
• Darrell Walters, PHD
• Chelsea Wan, L.AC.
• Canty Wang
• Fang Yu Wang, DMD
• Fengtao Wang, L.AC
• Irene Wang

• Geriatric Medicine (Internal Medicine) Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.