Provider Demographics
NPI:1770330961
Name:MAUGHAN, KEVIN N
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:N
Last Name:MAUGHAN
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 1:140 FANTAGES WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8187
Mailing Address - Country:US
Mailing Address - Phone:916-827-1231
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5069
Practice Address - Country:US
Practice Address - Phone:916-388-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-04
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker