Provider Demographics
NPI:1760636211
Name:MURPHY, KEVIN THOMAS (LAC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:MURPHY
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 1:27 STASIA DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-1944
Mailing Address - Country:US
Mailing Address - Phone:415-717-1588
Mailing Address - Fax:
Practice Address - Street 1:60 LIBERTY SHIP WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3309
Practice Address - Country:US
Practice Address - Phone:415-717-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8342171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist