Provider Demographics
NPI:1508810292
Name:CARSON, KENT STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:STEVEN
Last Name:CARSON
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 1:9460 N NAME UNO STE 210
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3532
Mailing Address - Country:US
Mailing Address - Phone:408-847-0888
Mailing Address - Fax:
Practice Address - Street 1:9460 N NAME UNO STE 210
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3532
Practice Address - Country:US
Practice Address - Phone:408-847-0888
Practice Address - Fax:408-847-1257
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30260207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2615602OtherTAX ID
CA00G302600Medicare ID - Type UnspecifiedPROVIDER#
CAA44352Medicare UPIN