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General NPI Number Information
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NPI Number | 1912324443
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Entity Type | Organization
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Legal Business Name | KEVIN KINBACK
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 333 CORPORATE DR STE 260
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City | LADERA RANCH
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State | CA
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Zip | 92694-2180
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Country | US
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Telephone | 949-768-2988
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Fax | 949-768-2980
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Provider Business Mailing Address
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Address Line | PO BOX 7450
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-7450
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Country | US
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Telephone | 949-768-2988
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Fax | 949-768-2980
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN M KINBACK
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Credential | MD
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Telephone | 949-768-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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