Healthcare Provider Details

I. General information

NPI: 1508931023
Provider Name (Legal Business Name): KEVIN H HOVEIDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HOUMAN HOVEIDA

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 6TH AVE
SAN DIEGO CA
92103-2202
US

IV. Provider business mailing address

4033 6TH. AVE. EXTENSION
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-9856
  • Fax: 619-297-9236
Mailing address:
  • Phone: 619-298-9856
  • Fax: 619-297-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA46063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA46063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: