1538324033 NPI number — KEVEN PATRICK O'BRIEN

Table of content: KEVEN PATRICK O'BRIEN (NPI 1538324033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538324033 NPI number — KEVEN PATRICK O'BRIEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRIEN
Provider First Name:
KEVEN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBRIEN
Provider Other First Name:
KEVIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538324033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 N BUSH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92706-2816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-361-7950
Provider Business Mailing Address Fax Number:
714-361-7966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 BAKER ST E
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COSTA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92626-4566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-361-6760
Provider Business Practice Location Address Fax Number:
714-361-6768
Provider Enumeration Date:
07/23/2008

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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