Provider Demographics
NPI:1063158426
Name:PETERSEN, KEVIN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 QUARRY ROAD
Mailing Address - Street 2:DEPARTMENT OF OBGYN, MC 5317
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1419
Mailing Address - Country:US
Mailing Address - Phone:650-498-7570
Mailing Address - Fax:
Practice Address - Street 1:423 QUARRY ROAD
Practice Address - Street 2:DEPARTMENT OF OBGYN, MC 5317
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1419
Practice Address - Country:US
Practice Address - Phone:650-498-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program