Provider Demographics
NPI:1720388002
Name:KEVIN A. KIRBY, DPM, INC.
Entity Type:Organization
Organization Name:KEVIN A. KIRBY, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:916-925-8111
Mailing Address - Street 1:107 SCRIPPS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6300
Mailing Address - Country:US
Mailing Address - Phone:916-925-8111
Mailing Address - Fax:916-925-8136
Practice Address - Street 1:107 SCRIPPS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6300
Practice Address - Country:US
Practice Address - Phone:916-925-8111
Practice Address - Fax:916-925-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3210213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11579Medicare UPIN
000E32100Medicare Oscar/Certification