Provider Demographics
NPI:1932211570
Name:FELDMAN, KENT A (DPM)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:A
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 KEARNY VILLA RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1143
Mailing Address - Country:US
Mailing Address - Phone:858-571-0606
Mailing Address - Fax:858-571-1933
Practice Address - Street 1:5471 KEARNY VILLA RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1143
Practice Address - Country:US
Practice Address - Phone:858-571-0606
Practice Address - Fax:858-571-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3609213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE3609AOtherMEDICARE PROVIDER ID
CAWE3609AOtherMEDICARE PROVIDER ID
CAU02617Medicare UPIN