Provider Demographics
NPI:1619053790
Name:JUSTUS, KEVIN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROSS
Last Name:JUSTUS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1421
Mailing Address - Country:US
Mailing Address - Phone:310-393-7147
Mailing Address - Fax:310-451-6286
Practice Address - Street 1:530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1421
Practice Address - Country:US
Practice Address - Phone:310-393-7147
Practice Address - Fax:310-451-6286
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2020-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79053207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine