Healthcare Provider Details

I. General information

NPI: 1861927691
Provider Name (Legal Business Name): ALEXANDER NICHOLAS KAYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 ROLLING OAKS DR STE 210
THOUSAND OAKS CA
91361
US

IV. Provider business mailing address

375 ROLLING OAKS DR STE 210
THOUSAND OAKS CA
91361-1028
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-7015
  • Fax:
Mailing address:
  • Phone: 805-497-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: