Provider Demographics
NPI:1922721976
Name:KEVIN J. PELTON MD, INC.
Entity Type:Organization
Organization Name:KEVIN J. PELTON MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:PELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-7600
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 2200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2476
Mailing Address - Country:US
Mailing Address - Phone:323-264-7600
Mailing Address - Fax:323-261-8027
Practice Address - Street 1:1127 WILSHIRE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3905
Practice Address - Country:US
Practice Address - Phone:323-271-4173
Practice Address - Fax:213-621-9584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty