Provider Demographics
NPI:1750480133
Name:POWELL, KENT LEIGHTON (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:LEIGHTON
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:31407 EAST NINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2911
Mailing Address - Country:US
Mailing Address - Phone:949-363-9842
Mailing Address - Fax:949-388-5232
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE 105 B
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-363-9842
Practice Address - Fax:949-388-5232
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC241372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A86916Medicare UPIN
A86916Medicare UPIN