Provider Demographics
NPI:1437626181
Name:KILMURRAY, KEVIN JACOB
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JACOB
Last Name:KILMURRAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 CALHOUN PL STE D
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4403
Mailing Address - Country:US
Mailing Address - Phone:951-652-8000
Mailing Address - Fax:951-652-8006
Practice Address - Street 1:949 CALHOUN PL STE D
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4403
Practice Address - Country:US
Practice Address - Phone:951-652-8000
Practice Address - Fax:951-652-8006
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56224363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical