Provider Demographics
NPI:1811159387
Name:KENT, KATHRYN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARIE
Last Name:KENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2290 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-2929
Mailing Address - Country:US
Mailing Address - Phone:707-643-5785
Mailing Address - Fax:707-643-8810
Practice Address - Street 1:2290 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-2929
Practice Address - Country:US
Practice Address - Phone:707-643-5785
Practice Address - Fax:707-643-8810
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RILP01393208600000X
MA244334207NI0002X
FLME119347207N00000X
CAA138610207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology