1922219880 NPI number — KEVIN R. HILTON, 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 1922219880 NPI number — KEVIN R. HILTON, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEVIN R. HILTON, 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:
CALIFORNIA SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1922219880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 E ROSEVILLE PKWY STE 140355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-3078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-781-9101
Provider Business Mailing Address Fax Number:
916-781-9102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 N SUNRISE AVE STE 230A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-781-9101
Provider Business Practice Location Address Fax Number:
916-781-9102
Provider Enumeration Date:
05/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILTON
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
916-781-9101

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G079838 , 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)