Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1912925918 Deactivated / Inactive NPI Male Practitioner

Dr. Kenneth Raymond Roth , MD

Specialist • Poway, CA

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Kenneth Roth has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 17, 2006
NPI Deactivation Date April 29, 2019
Total Practice Duration ~13 Years of Practice (2006 – 2019)

Professional Overview & Biography Verified Profile Summary

Dr. Kenneth Roth, MD was a registered Specialist practicing in Poway, CA. Throughout an active medical career spanning 13 years, Dr. Roth provided care at the practice location at 13636 JACK RABBIT RD until profile deactivation on 2019-04-29.

Practice Location & Contact Primary Location

Practice Address

13636 Jack Rabbit Rd

Poway, CA 920641702

Telephone 8588421246
Fax 8588421246

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Poway, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 36.7 Yrs
State Avg: 38.0 Yrs
Regional Practice Density
18 Specialists

Practicing in Poway, CA (6446 Statewide)

Telehealth Adoption Rate
11.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License CA G10668

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
⚠️
NPI Profile Deactivated April 29, 2019

Record deactivated on April 29, 2019

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 13636 JACK RABBIT RD, POWAY, CA 920641702 (Tel: 8588421246)

📍
Updated Business Mailing Address July 08, 2007

Registered at PO BOX 501173, SAN DIEGO, CA 921501173 (Tel: 8588421246)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as KENNETH ROTH, M.D.

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Specialist (License #G10668 in CA)

🟢
Initial NPI Registration & Enumeration July 17, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews
No patient reviews submitted yet for Dr. Kenneth Roth. Be the first to share your experience!

Sign in to leave a review for Dr. Kenneth Roth

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1912925918
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 17, 2006
Last Update: July 08, 2007
Deactivation Date: April 29, 2019

Mailing Address

Po Box 501173

San Diego, CA 921501173

Phone: 8588421246

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.