Healthcare Provider Details

I. General information

NPI: 1114251477
Provider Name (Legal Business Name): KEVIN PATRICK BYRNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12073 WORLD TRADE DR SUITE 3
SAN DIEGO CA
92128-4391
US

IV. Provider business mailing address

12073 WORLD TRADE DR SUITE 3
SAN DIEGO CA
92128-4391
US

V. Phone/Fax

Practice location:
  • Phone: 858-472-6632
  • Fax: 858-613-0524
Mailing address:
  • Phone: 858-472-6632
  • Fax: 858-613-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberC51555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: