Healthcare Provider Details

I. General information

NPI: 1568782662
Provider Name (Legal Business Name): KEVIN SOMAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 KINGSLEY AVE STE 300
ORANGE PARK FL
32073-4898
US

IV. Provider business mailing address

330 CORPORATE WAY STE 300
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-621-0643
  • Fax: 833-576-2330
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME122923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: