Provider Demographics
NPI:1497817993
Name:PARZYCH, KEVIN KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KENNETH
Last Name:PARZYCH
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 1:285 SOUTH ST STE J
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5037
Mailing Address - Country:US
Mailing Address - Phone:805-547-7025
Mailing Address - Fax:805-547-7029
Practice Address - Street 1:1234 LAUREL LN
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5860
Practice Address - Country:US
Practice Address - Phone:801-918-4238
Practice Address - Fax:805-782-8723
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55876207Q00000X, 207QA0505X, 207QH0002X
UT3362971205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC55876OtherLICENSE
CAC55876OtherLICENSE