Provider Demographics
NPI:1407972185
Name:KEVIN S FINNESEY MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KEVIN S FINNESEY MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FINNESEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-558-0504
Mailing Address - Street 1:100 S ELLSWORTH AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3939
Mailing Address - Country:US
Mailing Address - Phone:650-343-5633
Mailing Address - Fax:650-343-3122
Practice Address - Street 1:100 S ELLSWORTH AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3939
Practice Address - Country:US
Practice Address - Phone:650-343-5633
Practice Address - Fax:650-343-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71098207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71098OtherLICENSE NUMBER
CAZZZ05858ZMedicare PIN
CAG71098OtherLICENSE NUMBER