Healthcare Provider Details

I. General information

NPI: 1932211570
Provider Name (Legal Business Name): KENT A FELDMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 KEARNY VILLA RD. SUITE 200
SAN DIEGO CA
92123-1143
US

IV. Provider business mailing address

5471 KEARNY VILLA RD. SUITE 200
SAN DIEGO CA
92123-1143
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-0606
  • Fax: 858-571-1933
Mailing address:
  • Phone: 858-571-0606
  • Fax: 858-571-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE3609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: