Provider Demographics
NPI:1194739227
Name:HUSTON, KENT K (MD)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:K
Last Name:HUSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 BROADWAY BLVD STE 40
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3315
Mailing Address - Country:US
Mailing Address - Phone:816-531-0930
Mailing Address - Fax:816-753-2671
Practice Address - Street 1:4440 BROADWAY BLVD STE 40
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3315
Practice Address - Country:US
Practice Address - Phone:816-531-0930
Practice Address - Fax:816-753-2671
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59090207RR0500X
MO2006039224207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH45429Medicare UPIN