Healthcare Provider Details

I. General information

NPI: 1730665100
Provider Name (Legal Business Name): KYLE THOMAS O'MEARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 155
PASADENA CA
91105-3027
US

IV. Provider business mailing address

10 CONGRESS ST STE 155
PASADENA CA
91105-3027
US

V. Phone/Fax

Practice location:
  • Phone: 626-486-0181
  • Fax: 626-486-0189
Mailing address:
  • Phone: 626-486-0181
  • Fax: 626-486-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA183961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: