Provider Demographics
NPI:1922028489
Name:KEVIN M. RUHGE, M.D., INC.
Entity Type:Organization
Organization Name:KEVIN M. RUHGE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUHGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-397-9095
Mailing Address - Street 1:50 ALESSANDRO PL STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4001
Mailing Address - Country:US
Mailing Address - Phone:626-397-9095
Mailing Address - Fax:626-397-9099
Practice Address - Street 1:50 ALESSANDRO PL STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4001
Practice Address - Country:US
Practice Address - Phone:626-397-9095
Practice Address - Fax:626-397-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65129208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A651290Medicaid
CAP00118753Medicare ID - Type UnspecifiedRAILROAD MEDICARE
CA00A651290Medicaid