Healthcare Provider Details

I. General information

NPI: 1922028489
Provider Name (Legal Business Name): KEVIN M. RUHGE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALESSANDRO PL STE 300
PASADENA CA
91105-4001
US

IV. Provider business mailing address

50 ALESSANDRO PL STE 300
PASADENA CA
91105-4001
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-9095
  • Fax: 626-397-9099
Mailing address:
  • Phone: 626-397-9095
  • Fax: 626-397-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA65129
License Number StateCA

VIII. Authorized Official

Name: DR. KEVIN M. RUHGE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-397-9095