1508847500 NPI number — KENNETH P VIVES MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	VIVES
Provider First Name	:	KENNETH
Provider Middle Name	:	P
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	MD
Provider Gender Code	:	M

Provider Other Organization Name	:
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Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
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Provider Other Name Suffix Text	:
Provider Other Credential Text	:
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NPI Number	:	1508847500
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	04/07/2011
NPI Deactivation Reason Code	:
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Provider First Line Business Mailing Address	:	800 HOWARD AVE
Provider Second Line Business Mailing Address	:	YALE PHYSICIANS' BUILDING, 3RD FL
Provider Business Mailing Address City Name	:	NEW HAVEN
Provider Business Mailing Address State Name	:	CT
Provider Business Mailing Address Postal Code	:	065191369
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	2037852805
Provider Business Mailing Address Fax Number	:	2037856916

Provider First Line Business Practice Location Address	:	800 HOWARD AVE
Provider Second Line Business Practice Location Address	:	YALE PHYSICIANS' BUILDING, 3RD FL
Provider Business Practice Location Address City Name	:	NEW HAVEN
Provider Business Practice Location Address State Name	:	CT
Provider Business Practice Location Address Postal Code	:	065191369
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	2037852805
Provider Business Practice Location Address Fax Number	:	2037856916
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
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• Taxonomy code: 207T00000X , with the licence number:  039692 , registered in the state of CT .

• Identifier: 001396929 , issued by the state of ( CT ) . This identifiers is of the category "".
• Identifier: H45130 . This identifiers is of the category "".
• Identifier: 140000191 , issued by the state of ( CT ) . This identifiers is of the category "".