Provider Demographics
NPI:1003135799
Name:STEVEN A KIND M.D., MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEVEN A KIND M.D., MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIND
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:805-373-0177
Mailing Address - Street 1:2230 LYNN RD
Mailing Address - Street 2:330
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-373-0177
Mailing Address - Fax:805-373-5527
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:330
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-373-0177
Practice Address - Fax:805-373-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65029Medicare PIN