Provider Demographics
NPI:1639137490
Name:WHITE, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4546 EL CAMINO REAL STE B7
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1069
Mailing Address - Country:US
Mailing Address - Phone:866-362-4246
Mailing Address - Fax:650-260-6030
Practice Address - Street 1:4546 EL CAMINO REAL STE B7
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1069
Practice Address - Country:US
Practice Address - Phone:866-362-4246
Practice Address - Fax:650-260-6030
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA920522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry