Provider Demographics
NPI:1265452809
Name:BATES, KIN D SR (PA)
Entity Type:Individual
Prefix:
First Name:KIN
Middle Name:D
Last Name:BATES
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 EUREKA WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0427
Mailing Address - Country:US
Mailing Address - Phone:530-244-3278
Mailing Address - Fax:530-244-3280
Practice Address - Street 1:3330 CHURN CREEK RD STE D4
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2532
Practice Address - Country:US
Practice Address - Phone:530-222-3287
Practice Address - Fax:530-222-8547
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12540Medicaid
CAOPA125400Medicare PIN
CAP86739Medicare UPIN