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General NPI Number Information
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NPI Number | 1497382477
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Entity Type | Individual
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Provider Name | KYLE TILLINGHAST MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1 MEDICAL PLAZA DR
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City | ROSEVILLE
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State | CA
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Zip | 95661-3037
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Country | US
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Telephone | 916-781-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3315 WATT AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-3600
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Country | US
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Telephone | 916-481-6800
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Fax | 916-481-1881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A197341
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License Number State | CA
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