Provider Demographics
NPI:1982716247
Name:BRENNER, KEVIN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N ROXBURY DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4206
Mailing Address - Country:US
Mailing Address - Phone:310-777-5400
Mailing Address - Fax:310-388-5352
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:SUITE 800
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-777-5400
Practice Address - Fax:310-388-5352
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA790322086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery