Provider Demographics
NPI:1992779219
Name:OSBURN, KEVIN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:OSBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 BATH ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4339
Mailing Address - Country:US
Mailing Address - Phone:805-682-7874
Mailing Address - Fax:805-682-7875
Practice Address - Street 1:2320 BATH ST
Practice Address - Street 2:SUITE 317
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4339
Practice Address - Country:US
Practice Address - Phone:805-682-7874
Practice Address - Fax:805-682-7875
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA O 42005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA O 42005OtherCALIFORNIA LICENSE
CA00A420050Medicaid
CAA O 42005OtherCALIFORNIA LICENSE
CAA42005Medicare ID - Type UnspecifiedMEDICARE #