Provider Demographics
NPI:1851375521
Name:TEEHEE, KEVIN NEAL (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:NEAL
Last Name:TEEHEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6861
Mailing Address - Country:US
Mailing Address - Phone:805-310-2134
Mailing Address - Fax:310-379-4856
Practice Address - Street 1:111 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6861
Practice Address - Country:US
Practice Address - Phone:805-310-2134
Practice Address - Fax:310-379-4856
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69135207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A691350Medicaid
CAA69135OtherMEDICAL LICENSE
CAA69135OtherMEDICAL LICENSE
CAH30666Medicare UPIN