Provider Demographics
NPI:1508931023
Name:HOVEIDA, KEVIN H (MD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:H
Last Name:HOVEIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOUMAN
Other - Middle Name:
Other - Last Name:HOVEIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4033 6TH. AVE. EXTENSION
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-298-9856
Mailing Address - Fax:619-297-9236
Practice Address - Street 1:4033 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2202
Practice Address - Country:US
Practice Address - Phone:619-298-9856
Practice Address - Fax:619-297-9236
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46063207RG0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A460630Medicaid
CA00A460630Medicaid
CAF02075Medicare UPIN