Provider Demographics
NPI:1205907227
Name:KIRBY, KEVIN A (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SCRIPPS DR
Mailing Address - Street 2:200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825
Mailing Address - Country:US
Mailing Address - Phone:916-925-8111
Mailing Address - Fax:916-925-8136
Practice Address - Street 1:107 SCRIPPS DR
Practice Address - Street 2:200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825
Practice Address - Country:US
Practice Address - Phone:916-925-8111
Practice Address - Fax:916-925-8136
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3210213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E32100Medicare ID - Type Unspecified
T11579Medicare UPIN