Healthcare Provider Details

I. General information

NPI: 1366079170
Provider Name (Legal Business Name): KEVIN STUART PINK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SAINT ANDREWS BLVD
CHARLESTON SC
29407-7156
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-6111
  • Fax: 843-727-2973
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number97874
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: