Healthcare Provider Details

I. General information

NPI: 1982804340
Provider Name (Legal Business Name): KEVIN L GOLDEN M.D, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 301
LAS VEGAS NV
89128
US

IV. Provider business mailing address

11025 RCA CENTER DR STE 301
PALM BEACH GARDENS FL
33410-4269
US

V. Phone/Fax

Practice location:
  • Phone: 877-562-5227
  • Fax: 702-938-9954
Mailing address:
  • Phone: 561-383-3820
  • Fax: 855-369-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number232375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: