Provider Demographics
NPI:1356213920
Name:DUNAVAN, KEVIN WAYNE
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:WAYNE
Last Name:DUNAVAN
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 1:13300 CROSSROADS PKWY N STE 450
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91746-3405
Mailing Address - Country:US
Mailing Address - Phone:800-201-7320
Mailing Address - Fax:
Practice Address - Street 1:13300 CROSSROADS PKWY N STE 450
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91746-3405
Practice Address - Country:US
Practice Address - Phone:800-201-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health