1194734046 NPI number — KENT L. POWELL, M.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194734046 NPI number — KENT L. POWELL, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENT L. POWELL, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194734046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31407 EAST NINE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGUNA NIGUEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92677-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-363-9842
Provider Business Mailing Address Fax Number:
949-388-5232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30011 IVY GLENN DR
Provider Second Line Business Practice Location Address:
SUITE 105 B
Provider Business Practice Location Address City Name:
LAGUNA NIGUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92677-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-363-9842
Provider Business Practice Location Address Fax Number:
949-388-5232
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POWELL
Authorized Official First Name:
KENT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-363-9842

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  C24137 , 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)





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