Provider Demographics
NPI:1528348141
Name:LOHENRY, KEVIN (PHD, PA-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:LOHENRY
Suffix:
Gender:M
Credentials:PHD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE
Mailing Address - Street 2:UNIT 7, BLDG A11, ROOM 11156
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8800
Mailing Address - Country:US
Mailing Address - Phone:626-457-4262
Mailing Address - Fax:626-457-4245
Practice Address - Street 1:4368 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1606
Practice Address - Country:US
Practice Address - Phone:626-579-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21755363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical