Provider Demographics
NPI:1275598831
Name:HILTON, KEVIN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICHARD
Last Name:HILTON
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 1:1235 W VINE ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-5144
Mailing Address - Country:US
Mailing Address - Phone:209-334-8520
Mailing Address - Fax:209-334-2109
Practice Address - Street 1:1235 W VINE ST
Practice Address - Street 2:SUITE 22
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5144
Practice Address - Country:US
Practice Address - Phone:209-334-8520
Practice Address - Fax:209-334-2109
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079838207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31056ZMedicare PIN
CAG75181Medicare UPIN