Provider Demographics
NPI:1215285564
Name:BLUNT, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BLUNT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 PAYNE AVE
Mailing Address - Street 2:APT # 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-3327
Mailing Address - Country:US
Mailing Address - Phone:408-849-6544
Mailing Address - Fax:
Practice Address - Street 1:4230 PAYNE AVE
Practice Address - Street 2:APT # 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-3327
Practice Address - Country:US
Practice Address - Phone:408-849-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)