Provider Demographics
NPI:1922206465
Name:ANDRUSS, KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:ANDRUSS
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 1:12401 E. WASHINGTON BLVD
Mailing Address - Street 2:INTERCOMMUNITY EMERGENCY MEDICAL GROUP
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-945-5283
Practice Address - Street 1:12401 E. WASHINGTON BLVD
Practice Address - Street 2:INTERCOMMUNITY EMERGENCY MEDICAL GROUP
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:562-945-5283
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105449207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine