Provider Demographics
NPI:1790221810
Name:KEARNS, CHAD (PD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:KEARNS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16162 JACKSON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SILVERADO
Mailing Address - State:CA
Mailing Address - Zip Code:92676-9706
Mailing Address - Country:US
Mailing Address - Phone:714-681-3994
Mailing Address - Fax:949-645-3235
Practice Address - Street 1:16162 JACKSON RANCH RD
Practice Address - Street 2:
Practice Address - City:SILVERADO
Practice Address - State:CA
Practice Address - Zip Code:92676-9706
Practice Address - Country:US
Practice Address - Phone:714-681-3994
Practice Address - Fax:949-645-3235
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428171835N1003X, 1835P0018X, 1835X0200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology