Provider Demographics
NPI:1285375725
Name:WILLIAMS, KEVIN DIETRICH (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DIETRICH
Last Name:WILLIAMS
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 1:28062 BAXTER ROAD
Mailing Address - Street 2:ATTENTION: RENEE SAYEGH
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1401
Mailing Address - Country:US
Mailing Address - Phone:951-290-4168
Mailing Address - Fax:
Practice Address - Street 1:28062 BAXTER ROAD OFFICE OF GME FAMILY MEDICINE PROGRAM
Practice Address - Street 2:ATTENTION: RENEE SAVEGH
Practice Address - City:MURRIETA CA
Practice Address - State:CA
Practice Address - Zip Code:92563-1401
Practice Address - Country:US
Practice Address - Phone:951-290-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program