Provider Demographics
NPI:1194896746
Name:HILER, KEVIN RICHARD (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RICHARD
Last Name:HILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:R
Other - Last Name:HILER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:SUITE 612
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-601-4186
Mailing Address - Fax:415-358-4485
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 612
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-601-4186
Practice Address - Fax:415-358-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC393570208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C393571Medicaid
00C393570Medicare ID - Type Unspecified
CA00C393571Medicaid