MEDICARE: DR. KEVIN DARREN SUGGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC24229	CA

General Provider Information

NPI Number	:	1023707213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DARREN SUGGS

Provider Business Mailing Address
First Line	:	18341 SHERMAN WAY STE 101
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4437
Country	:	US
Telephone Number	:	213-923-2695
Fax Number	:

Provider Business Practice Location Address
First Line	:	18341 SHERMAN WAY STE 101
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-4437
Country	:	US
Telephone Number	:	818-344-1089
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	05/03/2023

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