Provider Demographics
NPI:1164518593
Name:HUTTON, KATHLEEN P (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:P
Last Name:HUTTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-8556
Mailing Address - Fax:949-644-6318
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-8556
Practice Address - Fax:949-644-6318
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71065207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G710650OtherBLUE SHIELD OF CALIFORNIA
CA00G710650OtherBLUE SHIELD OF CALIFORNIA
F1089Medicare UPIN