MEDICARE: DR. MICHAEL A. KENT

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
1	207Q00000X	Family Medicine Physician	A37009	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	330-35-8595	OTHER	CA	TAX ID #

General Provider Information

NPI Number	:	1952335598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A. KENT

Provider Business Mailing Address
First Line	:	25500 RANCHO NIGUEL RD
Second Line	:	STE 100
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7373
Country	:	US
Telephone Number	:	949-643-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	25500 RANCHO NIGUEL
Second Line	:	100
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-7302
Country	:	US
Telephone Number	:	949-643-0500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/21/2008

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