Provider Demographics
NPI:1073563045
Name:DEGNAN, KEVIN FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:FRANCIS
Last Name:DEGNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 YGNACIO VALLEY RD
Mailing Address - Street 2:BUILDING H 202
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-935-4500
Mailing Address - Fax:
Practice Address - Street 1:2021 YGNACIO VALLEY RD
Practice Address - Street 2:BUILDING H. SUITE 202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-935-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45349208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453490Medicaid
CA00A453490Medicaid
CAF24266Medicare UPIN