Provider Demographics
NPI:1144680141
Name:SORENSEN, KEVIN R (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 MANGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3509
Mailing Address - Country:US
Mailing Address - Phone:530-345-0064
Mailing Address - Fax:530-345-0680
Practice Address - Street 1:1040 MANGROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3509
Practice Address - Country:US
Practice Address - Phone:530-345-0064
Practice Address - Fax:530-345-0680
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18076208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty