Healthcare Provider Details

I. General information

NPI: 1760444731
Provider Name (Legal Business Name): KEVIN CHARLES O'BRIEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE 3RD FLOOR
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE 3RD FLOOR
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8743
  • Fax: 562-933-8764
Mailing address:
  • Phone: 562-933-8743
  • Fax: 562-933-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA82855
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA82855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: