Provider Demographics
NPI:1841350832
Name:MAN, KEVIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:MAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SHRADER STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1044
Mailing Address - Country:US
Mailing Address - Phone:415-362-3336
Mailing Address - Fax:415-362-7542
Practice Address - Street 1:1 SHRADER STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1044
Practice Address - Country:US
Practice Address - Phone:415-362-3336
Practice Address - Fax:415-362-7542
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66113207RI0008X, 174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841350832OtherMEDICARE NPI
CAF06770Medicare UPIN
CA00G661130Medicare PIN