Provider Demographics
NPI:1457637340
Name:PAPE, KEVIN ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANTHONY
Last Name:PAPE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:ANTHONY
Other - Last Name:BARRETT-PAPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 E HARDY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4054
Mailing Address - Country:US
Mailing Address - Phone:310-672-3900
Mailing Address - Fax:310-672-9300
Practice Address - Street 1:501 E HARDY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4054
Practice Address - Country:US
Practice Address - Phone:310-672-3900
Practice Address - Fax:310-672-9300
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21891363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical