Provider Demographics
NPI:1821206871
Name:THURMAN, KENDALL V (DO)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:V
Last Name:THURMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9162 RENAISSANCE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9510
Mailing Address - Country:US
Mailing Address - Phone:804-238-2152
Mailing Address - Fax:
Practice Address - Street 1:14118 ASHTON COVE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-3990
Practice Address - Country:US
Practice Address - Phone:804-379-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202592207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12190266OtherCAQH