Provider Demographics
NPI:1194924100
Name:HARLEY, KEVIN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:HARLEY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:STE 135
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:703-961-0480
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:CITY TOWER, SUITE 400
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98051207RN0300X
VA01010263559207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty