Healthcare Provider Details

I. General information

NPI: 1982673406
Provider Name (Legal Business Name): KEVIN J. BORAN M.D., FACC, FSCAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E HERNDON AVE
FRESNO CA
93720-3235
US

IV. Provider business mailing address

1207 E HERNDON AVE
FRESNO CA
93720-3235
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-4303
  • Fax: 559-432-4574
Mailing address:
  • Phone: 559-432-4303
  • Fax: 559-432-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG56843
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG56843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: