Provider Demographics
NPI:1215193495
Name:AMAYA, KEVIN E (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:AMAYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25965 NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3416
Mailing Address - Country:US
Mailing Address - Phone:424-328-2094
Mailing Address - Fax:
Practice Address - Street 1:25965 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3416
Practice Address - Country:US
Practice Address - Phone:424-328-2094
Practice Address - Fax:424-328-2108
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10917207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty