Provider Demographics
NPI:1619082401
Name:BEAN, HARVEY KIM (DPM)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:KIM
Last Name:BEAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:KIM
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1801 N CARSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1216
Mailing Address - Country:US
Mailing Address - Phone:775-882-1441
Mailing Address - Fax:775-882-6844
Practice Address - Street 1:1801 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-1216
Practice Address - Country:US
Practice Address - Phone:775-882-1441
Practice Address - Fax:775-882-6844
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67114Medicare UPIN