Broder, Kevin Wayne

Broder, Kevin Wayne is an sole proprietor health care provider with primary practice located at 4510 Executive Drive Suite 200, San Diego CA 92121. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Broder, Kevin Wayne can be contacted via phone (858) 453-7224.

Contact Information

Primary practice address
4510 Executive Drive Suite 200 San Diego CA 92121
Phone: (858) 453-7224
Fax: (858) 453-7268
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X A82409 California

Profile Details

NPI number 1205885902
LBN Legal business name Broder, Kevin Wayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 9th, 2006
Last updated Sep 5th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205885902 NPPES
California MEDICAID 00A824090

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