Healthcare Provider Details

I. General information

NPI: 1164524815
Provider Name (Legal Business Name): KEVIN B HILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIERRA COLLEGE DR STE105
GRASS VALLEY CA
95945-5082
US

IV. Provider business mailing address

300 SIERRA COLLEGE DR STE105
GRASS VALLEY CA
95945-5082
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-3377
  • Fax:
Mailing address:
  • Phone: 530-273-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20A7076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: