Provider Demographics
NPI:1598760092
Name:RICHARDS, KURT MASON (PA - C)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:MASON
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PA - C
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Mailing Address - Street 1:7325 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1925
Mailing Address - Country:US
Mailing Address - Phone:818-981-2050
Mailing Address - Fax:818-981-2382
Practice Address - Street 1:7325 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1925
Practice Address - Country:US
Practice Address - Phone:818-981-2050
Practice Address - Fax:818-981-2382
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA14778363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP73749Medicare UPIN
CAWPA14778BMedicare PIN