Healthcare Provider Details

I. General information

NPI: 1861207664
Provider Name (Legal Business Name): KEVIN ANTONY SAWCHUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503
US

IV. Provider business mailing address

341 HIDDEN PINES RD
DEL MAR CA
92014
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2211
  • Fax: 951-898-0821
Mailing address:
  • Phone: 672-965-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number184642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: