Healthcare Provider Details

I. General information

NPI: 1194739227
Provider Name (Legal Business Name): KENT K. HUSTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROADWAY BLVD STE 40
KANSAS CITY MO
64111-3315
US

IV. Provider business mailing address

4440 BROADWAY BLVD STE 40
KANSAS CITY MO
64111-3315
US

V. Phone/Fax

Practice location:
  • Phone: 816-531-0930
  • Fax: 816-753-2671
Mailing address:
  • Phone: 816-531-0930
  • Fax: 816-753-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD59090
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2006039224
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: