Provider Demographics
NPI:1689847725
Name:METZGER, KEVIN (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:METZGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 MARSHALL AVE
Mailing Address - Street 2:#140
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2502
Mailing Address - Country:US
Mailing Address - Phone:310-994-2822
Mailing Address - Fax:
Practice Address - Street 1:10841 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3811
Practice Address - Country:US
Practice Address - Phone:310-994-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACF320CMedicare PIN
CACF320AMedicare PIN
CAH57099Medicare UPIN