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NPI Code Detail

MEDICARE: MR. PETER HARDY KASS M.D., M.ED

MEDICARE: MR. PETER HARDY KASS M.D., M.ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianA150601CA

General Provider Information

NPI Number : 1417319765
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER HARDY KASS M.D., M.ED
Provider Business Mailing Address
First Line : 600 WEST BROADWAY
Second Line : SUITE 700, PMB 354
City : SAN DIEGO
State : CA
Zip : 92101
Country : US
Telephone Number : 858-208-3595
Fax Number :
Provider Business Practice Location Address
First Line : 2130 NATIONAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92113-2209
Country : US
Telephone Number : 619-515-2382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2016
Last Update Date : 04/06/2021

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