Provider Demographics
NPI:1922061563
Name:WINN, KEVIN N
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:WINN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SLATER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4773
Mailing Address - Country:US
Mailing Address - Phone:714-887-0123
Mailing Address - Fax:714-657-5898
Practice Address - Street 1:10231 SLATER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4773
Practice Address - Country:US
Practice Address - Phone:714-887-0123
Practice Address - Fax:714-657-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5308650001Medicare NSC