Provider Demographics
NPI:1285783746
Name:HART, KEVIN G (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:HART
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 BAYWOOD AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1537
Mailing Address - Country:US
Mailing Address - Phone:650-344-6961
Mailing Address - Fax:650-344-6604
Practice Address - Street 1:2324 SANTA RITA RD STE 8
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4150
Practice Address - Country:US
Practice Address - Phone:925-846-1492
Practice Address - Fax:925-846-8273
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA60072207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64351Medicare UPIN
CA00A600720Medicare ID - Type Unspecified