Provider Demographics
NPI:1962598300
Name:KATHLEEN P HUTTON MD INC
Entity type:Organization
Organization Name:KATHLEEN P HUTTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-8556
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-8556
Mailing Address - Fax:949-644-6318
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-8556
Practice Address - Fax:949-644-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ564182OtherBLUE SHIELD OF CALIFORNIA
CAZZZ564182OtherBLUE SHIELD OF CALIFORNIA