Provider Demographics
NPI:1962721233
Name:DE COMINES, KEVIN JOHN (LAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOHN
Last Name:DE COMINES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20719 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6706
Mailing Address - Country:US
Mailing Address - Phone:310-739-9937
Mailing Address - Fax:818-912-6244
Practice Address - Street 1:12401 WILSHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1015
Practice Address - Country:US
Practice Address - Phone:310-826-2021
Practice Address - Fax:310-442-0524
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist