Provider Demographics
NPI:1750453700
Name:AZAREN, KENT H (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:H
Last Name:AZAREN
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:PO BOX 7039
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-0039
Mailing Address - Country:US
Mailing Address - Phone:562-424-0421
Mailing Address - Fax:562-427-8005
Practice Address - Street 1:3610 LONG BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4012
Practice Address - Country:US
Practice Address - Phone:562-424-0421
Practice Address - Fax:562-427-8005
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079620Medicaid
CAW13478Medicare ID - Type Unspecified
A92153Medicare UPIN