Provider Demographics
NPI:1649745902
Name:CATES, KEVIN H (LAC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:H
Last Name:CATES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 OLEMA RD APT 6
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1333
Mailing Address - Country:US
Mailing Address - Phone:415-497-0535
Mailing Address - Fax:
Practice Address - Street 1:55 PROFESSIONAL CENTER PKWY STE M
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2729
Practice Address - Country:US
Practice Address - Phone:415-497-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17304171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist