Provider Demographics
NPI:1700890100
Name:COMBS, KENT L (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:L
Last Name:COMBS
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 1:26726 CROWN VALLEY PKWY #200
Mailing Address - Street 2:HEAD AND NECK ASSOCIATES OF ORANGE COUNTY INC
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8003
Mailing Address - Country:US
Mailing Address - Phone:949-364-4361
Mailing Address - Fax:949-364-4495
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:# 200
Practice Address - City:LAGUNA BCH
Practice Address - State:CA
Practice Address - Zip Code:92651-6771
Practice Address - Country:US
Practice Address - Phone:949-364-4361
Practice Address - Fax:949-364-4495
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-06-12
Deactivation Date:2018-03-14
Deactivation Code:
Reactivation Date:2018-06-12
Provider Licenses
StateLicense IDTaxonomies
CAC27776207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C277760Medicaid
CA00C277760Medicaid
A33461Medicare UPIN