Healthcare Provider Details

I. General information

NPI: 1881666360
Provider Name (Legal Business Name): MICHEL JOHN KEARNS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MEDICAL CENTER SAN DIEGO 34800 BOB WILSON DRIVE
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

PSC 819 BOX 4503
FPO AE
09645-0046
US

V. Phone/Fax

Practice location:
  • Phone: 619-562-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA82110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number82110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: