Provider Demographics
NPI:1770640476
Name:STEWART, KURT D (X-RAY TECH)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:D
Last Name:STEWART
Suffix:
Gender:M
Credentials:X-RAY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5576 PASEO GILBERTO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5705
Mailing Address - Country:US
Mailing Address - Phone:714-906-8503
Mailing Address - Fax:
Practice Address - Street 1:4425 N SUNFLOWER AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2328
Practice Address - Country:US
Practice Address - Phone:626-339-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT 63662247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist