Healthcare Provider Details

I. General information

NPI: 1548552193
Provider Name (Legal Business Name): KEVIN WHITE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E MAIN ST STE 200
VENTURA CA
93003
US

IV. Provider business mailing address

2601 E MAIN ST STE 200
VENTURA CA
93003
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-7500
  • Fax: 805-643-7510
Mailing address:
  • Phone: 805-643-7500
  • Fax: 805-643-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA74767
License Number StateCA

VIII. Authorized Official

Name: KEVIN WHITE
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 805-643-7500