Healthcare Provider Details

I. General information

NPI: 1982103487
Provider Name (Legal Business Name): KATHRYN KENT MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 VILLA LN STE 208
NAPA CA
94558-6405
US

IV. Provider business mailing address

1163 MORNINGSIDE DR
NAPA CA
94558-6314
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-6053
  • Fax:
Mailing address:
  • Phone: 973-525-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA138610
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA138610
License Number StateCA

VIII. Authorized Official

Name: DR. KATHRYN MARIE KENT
Title or Position: PRESIDENT
Credential: MD
Phone: 973-525-5720