Provider Demographics
NPI:1952335598
Name:KENT, MICHAEL A
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:KENT
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 1:25500 RANCHO NIGUEL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7373
Mailing Address - Country:US
Mailing Address - Phone:949-643-0500
Mailing Address - Fax:
Practice Address - Street 1:25500 RANCHO NIGUEL
Practice Address - Street 2:100
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7302
Practice Address - Country:US
Practice Address - Phone:949-643-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330-35-8595OtherTAX ID #
CAWA37009BMedicare PIN