Healthcare Provider Details

I. General information

NPI: 1609060615
Provider Name (Legal Business Name): KEVIN F OGRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2007
Last Update Date: 09/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OCEAN HEIGHTS DR
NEWPORT COAST CA
92657-1302
US

IV. Provider business mailing address

31 OCEAN HEIGHTS DR
NEWPORT COAST CA
92657-1302
US

V. Phone/Fax

Practice location:
  • Phone: 949-715-6815
  • Fax: 949-715-6816
Mailing address:
  • Phone: 949-715-6815
  • Fax: 949-715-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG36845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: