Provider Demographics
NPI:1205979333
Name:DEAN, KEVIN KEITH
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:KEITH
Last Name:DEAN
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 1:18800 DELAWARE ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1959
Mailing Address - Country:US
Mailing Address - Phone:714-841-5333
Mailing Address - Fax:714-841-5303
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-841-5333
Practice Address - Fax:714-841-5303
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist