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General NPI Number Information
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NPI Number | 1336392604
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Entity Type | Organization
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Legal Business Name | KEVIN W. BRODER, M. D. INCORPORATED
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 8899 UNIVERSITY CENTER LN SUITE 350
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City | SAN DIEGO
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State | CA
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Zip | 92122-1013
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Country | US
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Telephone | 858-453-5344
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 LEBON DR UNIT 3204
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City | SAN DIEGO
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State | CA
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Zip | 92122-4593
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN BRODER
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Credential | MD
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Telephone | 858-453-5344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A82409
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License Number State | CA
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