Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | G74709 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G74709 | CA |
NPI | 1396753901 |
---|---|
Provider Name | Kevin Frank Kevorkian |
First Address | Toluca Lake, CA 91602 |
Second Address | Beverly Hills, CA 90210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2628029 | (05) | CA |
G30206 | (02) |