Provider Demographics
NPI:1508085259
Name:ROBINSON, KEVIN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 MCCLURE AVE APT U
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2282
Mailing Address - Country:US
Mailing Address - Phone:562-220-2557
Mailing Address - Fax:
Practice Address - Street 1:3706 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1528
Practice Address - Country:US
Practice Address - Phone:323-669-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant