Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 0101237730 | VA |
N | 111NI0900X | Internist | 0101237730 | VA |
Y | 207R00000X | Internist | C138416 | CA |
Y | 111NI0900X | Internist | C138416 | CA |
N | 207RC0200X | Critical Care Medicine | 0101237730 | VA |
N | 207RC0200X | Critical Care Medicine | C138416 | CA |
N | 207RC0200X | Critical Care Medicine | ME69825 | FL |
NPI | 1073574380 |
---|---|
Provider Name | Dr. Kurt Andival Henry |
First Address | Newport Beach, CA 92660-5958 |
Second Address | Newport Beach, CA 92660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 29/08/2018 |