Provider Demographics
NPI:1912324443
Name:KEVIN KINBACK
Entity Type:Organization
Organization Name:KEVIN KINBACK
Other - Org Name:ADVANCEDTMS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-768-2988
Mailing Address - Street 1:PO BOX 7450
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7450
Mailing Address - Country:US
Mailing Address - Phone:949-768-2988
Mailing Address - Fax:949-768-2980
Practice Address - Street 1:333 CORPORATE DR STE 260
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2180
Practice Address - Country:US
Practice Address - Phone:949-768-2988
Practice Address - Fax:949-768-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty