1427048321 NPI number — KEVIN G FLAIG M.D.

Table of content: KEVIN G FLAIG M.D. (NPI 1427048321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427048321 NPI number — KEVIN G FLAIG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLAIG
Provider First Name:
KEVIN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427048321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3156 VISTA WAY
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92056-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-439-6581
Provider Business Mailing Address Fax Number:
760-439-6585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25500 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-5965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-696-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G62226 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G622260 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".