Provider Demographics
NPI:1609626662
Name:DO, KEVIN M (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:DO
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
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Mailing Address - Street 1:10519 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3128
Mailing Address - Country:US
Mailing Address - Phone:818-621-1935
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-6597
Practice Address - Fax:717-531-7790
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAAA12345207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine