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General NPI Number Information
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NPI Number | 1083076442
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Entity Type | Organization
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Legal Business Name | KEVIN FARNAM, M.D., INC.
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Dates
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Enumeration Date | 03/24/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 65 N MADISON AVE STE 202
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City | PASADENA
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State | CA
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Zip | 91101-5248
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Country | US
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Telephone | 626-793-2246
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Fax | 844-272-2073
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Provider Business Mailing Address
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Address Line | 65 N MADISON AVE STE 202
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City | PASADENA
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State | CA
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Zip | 91101-5248
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Country | US
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Telephone | 626-793-2246
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Fax | 844-272-2073
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN FARNAM
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Credential | M.D.
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Telephone | 626-793-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A110001
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | A110001
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License Number State | CA
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