Healthcare Provider Details

I. General information

NPI: 1023451598
Provider Name (Legal Business Name): KYLIN KOVAC DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 WOODKING DR
IDAHO FALLS ID
83404-4736
US

IV. Provider business mailing address

3830 WOODKING DR
IDAHO FALLS ID
83404-4736
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-8393
  • Fax:
Mailing address:
  • Phone: 208-529-8393
  • Fax: 208-529-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLIN KOVAC
Title or Position: OWNER
Credential: DPM
Phone: 208-529-8393