Healthcare Provider Details

I. General information

NPI: 1164024394
Provider Name (Legal Business Name): WILLIAM F KIVETT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 SONOMA AVE STE 1A
SANTA ROSA CA
95405-4817
US

IV. Provider business mailing address

PO BOX 2196
WINDSOR CA
95492-2196
US

V. Phone/Fax

Practice location:
  • Phone: 707-275-6410
  • Fax: 707-275-6075
Mailing address:
  • Phone: 707-291-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM F KIVETT
Title or Position: OWNER
Credential: MD
Phone: 707-291-5096