Healthcare Provider Details

I. General information

NPI: 1720075385
Provider Name (Legal Business Name): KEVIN S HART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/18/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL GUAM FARENHOLT AVE, BLDG 50
AGANA HEIGHTS GU
96910
US

IV. Provider business mailing address

U.S. NAVAL HOSPITAL GUAM PSC 455 BOX 208
FPO AP
96540
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number29446
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number29446
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: