Provider Demographics
NPI:1447428735
Name:DAVID A KENT MD CHARTERED
Entity Type:Organization
Organization Name:DAVID A KENT MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-863-0860
Mailing Address - Street 1:5561 N GLENWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1336
Mailing Address - Country:US
Mailing Address - Phone:208-863-0860
Mailing Address - Fax:
Practice Address - Street 1:5516 N GLENWOOD ST
Practice Address - Street 2:STE B
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-9219
Practice Address - Country:US
Practice Address - Phone:208-863-0860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM56092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1378557Medicare PIN