| Organization Name: | KEN STARR MD ADDICTION MEDICINE GROUP |
| NPI Number: | 1598195810 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEN STARR (OWNER) |
| Mailing Address: | 1320 Van Beurden Dr Suite 103 Los Osos |
| State: | CA US |
| Postal Code: | 934023380 |
| Phone Number: | 6267979977 |
| Fax Number: | 6268442977 |
| NPI Enumeration Date: | 11/22/2013 |
| NPI Last Update Date: | 11/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |