Provider Demographics
NPI:1033282637
Name:PELTON, KEVIN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JEFFREY
Last Name:PELTON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1700 E. CESAR CHAVEZ AVE.
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2476
Mailing Address - Country:US
Mailing Address - Phone:323-264-7600
Mailing Address - Fax:323-261-8027
Practice Address - Street 1:1700 E. CESAR CHAVEZ AVE.
Practice Address - Street 2:SUITE 2200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2476
Practice Address - Country:US
Practice Address - Phone:323-264-7600
Practice Address - Fax:323-261-8027
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA80695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679771703OtherORG NPI
CAA80695OtherSTATE LICENSE