Provider Demographics
NPI:1609966761
Name:KAY, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:KAY
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 1:16822 VIA LA COSTA
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1970
Mailing Address - Country:US
Mailing Address - Phone:310-230-2281
Mailing Address - Fax:310-230-2282
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1500
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-2882
Practice Address - Fax:310-203-9384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48892174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG48892BMedicare PIN
CAC17747Medicare UPIN