Provider Demographics
NPI:1437250859
Name:KAISERMAN, KEVIN BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRADLEY
Last Name:KAISERMAN
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 1:1401 W MERCED AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3401
Mailing Address - Country:US
Mailing Address - Phone:626-813-9988
Mailing Address - Fax:626-813-0075
Practice Address - Street 1:1401 W MERCED AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3401
Practice Address - Country:US
Practice Address - Phone:626-813-9988
Practice Address - Fax:626-813-0075
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG788312080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G788310Medicaid
CAG68201Medicare UPIN