Provider Demographics
NPI:1710035985
Name:HAMBY, KEVIN ALAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ALAN
Last Name:HAMBY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:714-347-1010
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:5801 NORRIS CANYON RD STE 230
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5440
Practice Address - Country:US
Practice Address - Phone:925-275-9910
Practice Address - Fax:925-275-9823
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3463367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA165112 (EA-CC)Medicare PIN
CACA165115 (EA-SC)Medicare PIN
CACA165114 (EA-SF)Medicare PIN
CACA165113 (EA-MC)Medicare PIN
CACA165116 (EA-AL)Medicare PIN