Healthcare Provider Details

I. General information

NPI: 1669533030
Provider Name (Legal Business Name): MICHAEL W KEMP MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 HURLEY WAY STE B
SACRAMENTO CA
95864-3789
US

IV. Provider business mailing address

2620 HURLEY WAY STE B
SACRAMENTO CA
95864-3789
US

V. Phone/Fax

Practice location:
  • Phone: 916-483-9064
  • Fax: 916-483-3514
Mailing address:
  • Phone: 916-483-9064
  • Fax: 916-483-3514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: